目的：通过检测脓毒血症患者褪黑素水平，探讨其与病情严重程度、炎症相关指标和死亡率的相关性。方法：收入脓毒血症患者64例，采集其临床信息和血清样品。根据第30天生存与否将患者分为生存组（43例）和死亡组（21例）。应用酶联免疫吸附（ELISA）法检测血清褪黑素、干扰素-γ（IFN-γ）及白介素-4（IL-4）水平。结果：血清褪黑素水平生存组为（13.19±0.807） pg·ml^-1，死亡组为（18.53±1.257） pg·ml^-1，两组间差异有统计学意义（P<0.001）。褪黑素水平>15 pg·ml^-1患者的30 d生存率显著低于褪黑素水平<15 pg·ml^-1者（P=0.002），且褪黑素水平是30 d死亡率的独立危险因子（P=0.001）。褪黑素水平与胆红素、乳酸、序贯器官衰竭估计（SOFA）评分、急性生理与慢性健康Ⅱ（APACHEⅡ）评分及IL-4评分呈显著正相关，与住院时间及机械通气天数呈显著负相关。结论：脓毒血症患者的褪黑素水平是死亡率的独立危险因子，对其检测有较高的临床应用价值。

[1] CAGNACCI A. Melatonin in relation to physiology in adult humans[J].J Pineal Res,1996,21(4):200-213.
[2] 裴华.PCT、LAC/ScvO2对脓毒血症患者病情与预后的评估价值[J].现代医学,2016,44(10):1419-1422.
[3] GALANO A,TAN D X,REITER R J.Melatonin as a natural ally against oxidative stress:a physicochemical examination[J].J Pineal Res,2011,51(1):1-16.
[4] ALBERTO D R,PEDRO A G,MARTIN G,et al.Light/dark patterns of interleukin-6 in relation to the pineal hormone melatonin in patients with acute myocardial infarction[J].Cytokine,2004,26(2):89-93.
[5] 丁可,李桃,文立利,等.褪黑素抑制脑创伤后炎症反应的机制研究[J].中华神经外科疾病研究杂志,2015,14(6):501-504.
[6] 徐玉生,李星晨,金伟林,等.褪黑素对急性脊髓损伤大鼠炎症反应的影响[J].中华物理医学与康复杂志,2014,36(4):260-265.
[7] REITER R J,PAREDES S D,MANCHESTER L C,et al.Reducing oxidative/nitrosative stress:a newly-discovered genre for melatonin[J].Crit Rev Biochem Mol Biol,2009,44(4):175-200.
[8] 王文昭,缪明永,邵福源,等.褪黑素对脑缺血后线粒体的影响[J].中华老年心脑血管病杂志,2000,2(5):343-346.
[9] 吴晨光,王丽,高静,等.褪黑素对糖尿病大鼠线粒体保护机制的研究[J].中华老年医学杂志,2010,29(12):1025-1028.
[10] ORTIZ F,GARCIA J A,DARIO A C,et al.The beneficial effects of melatonin against heart mitochondrial impairment during sepsis:inhibition of iNOS and preservation of nNOS[J].J Pineal Res,2014,56(1):71-81.
[11] MARTIN M,MACIAS M,ESCAMES G,et al.Melatonin-induced increased activity of the respiratory chain complexes I and IV can prevent mitochondrial damage induced by ruthenium red in vivo[J].J Pineal Res,2000,28(4):242-248.
[12] ZHAO L,AN R,YANG Y,et al.Melatonin alleviates brain injury in mice subjected to cecal ligation and puncture via attenuating inflammation,apoptosis,and oxidative stress:the role of SIRT1 signaling[J].J Pineal Res,2015,59(2):230-239.
[13] PERRAS B,KUROWSKI V,DODT C.Nocturnal melatonin concentration is correlated with illness severity in patients with septic disease[J].Intensive Care Med,2006,32(4):624-625.
[14] BAGCI S,HOROZ O O,YILDIZDAS D,et al.Melatonin status in pediatric intensive care patients with sepsis[J].Pediatr Crit Care Med,2012,13(2):120-123.
[15] DING K,XU J,WANG H,et al.Melatonin protects the brain from apoptosis by enhancement of autophagy after traumatic brain injury in mice[J].Neurochem Int,2015,91:46-54.
[16] 高曲文,陈俊抛,田时雨.β淀粉样蛋白诱导脑内神经元凋亡及褪黑素的保护作用[J].中华神经科杂志,2000,33(1):7-9.