Melatonin secretion and metabolism in patients with hepatic encephalopathy
Cezary Chojnacki
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorPatrycja Wachowska-Kelly
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorJanusz Błasiak
Department of Molecular Genetics, University of Lodz, Lodz, Poland
Search for more papers by this authorRussel J Reiter
Department of Cellular and Structural Biology, The University of Texas, Health Science Center, San Antonio, Texas, USA
Search for more papers by this authorCorresponding Author
Jan Chojnacki
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Correspondence
Professor Jan Chojnacki, Department of Gastroenterology, Medical University of Lodz, 1 Haller's Square, 90-647 Lodz, Poland. Email: [email protected]
Search for more papers by this authorCezary Chojnacki
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorPatrycja Wachowska-Kelly
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorJanusz Błasiak
Department of Molecular Genetics, University of Lodz, Lodz, Poland
Search for more papers by this authorRussel J Reiter
Department of Cellular and Structural Biology, The University of Texas, Health Science Center, San Antonio, Texas, USA
Search for more papers by this authorCorresponding Author
Jan Chojnacki
Department of Gastroenterology, Medical University of Lodz, Lodz, Poland
Correspondence
Professor Jan Chojnacki, Department of Gastroenterology, Medical University of Lodz, 1 Haller's Square, 90-647 Lodz, Poland. Email: [email protected]
Search for more papers by this authorAbstract
Background and Aim
The rhythm of melatonin secretion and its blood level changes in cirrhotic patients, but the causes of these alterations have not been sufficiently appreciated.
The aim of study was to estimate the dependence between melatonin secretion and metabolism and the severity of hepatic encephalopathy.
Methods
The study included 75 alcoholic cirrhotic patients (A, B, C) with hepatic insufficiency and 25 healthy subjects (group K). Three groups of patients were identified, 25 patients each, with grade 1, 2, and 3 hepatic encephalopathy according to West-Haven Scale. Immunoenzymatic method was used to measure serum melatonin (at 02:00 h and 09:00 h) level and 6-sulfatoxymelatonin (6-HMS) excretion in the urine (during night and day).
Results
Nocturnal serum melatonin levels (pg/mL) in groups were: K—57.1 ± 11.4, A—38.5 ± 11.2, B—53.4 ± 17.9, C—79.5 ± 27.9 (P < 0.01); whereas diurnal levels were: K—10.9 ± 3.5, A—33.5 ± 12.0, B—53.8 ± 23.1, C—98.5 ± 34.6 (P < 0.01). Similar differences were found in the evaluation of 6-HMS excretion (μg/9 h) in urine at night: group K—23.4 ± 14.4, A–16.6 ± 5.4, B—14.3 ± 6.2 (P < 0.01), C—3.3 ± 1.5 (P < 0.001). Diurnal 6-HMS excretion (μg/15 h) was lower only in group C and it was respectively: K—6.9 ± 3.4, A–7.1 ± 1.7, B—7.6 ± 1.7, C—4.3 ± 2.2 (P < 0.001). Serum ammonia concentrations (μg/dL) were: group K—30.4 ± 8.9, A–51.8 ± 25.4 (P < 0.05), B—73.0 ± 29.8 (P < 0.001), C—107.5 ± 34.8 (P < 0.001). No correlation between melatonin and ammonia levels in all groups was found.
Conclusions
The elevated melatonin blood levels both at night and day may account for some of the clinical manifestations of hepatic encephalopathy (daytime sleepiness, fatigue).
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