Correlation Between Plasma Melatonin Levels In Patients With Wake-Up Stroke

ObjectiveThis study to observe the changes of plasma melatonin levels and its circadian rhythm in patients with wake-up stroke,the study also to investigate the relationship between melatonin levels and risk factors of cerebral infarction and its clinical significance.Methods1.Study subjects: 72 patients with acute ischemic stroke(AIS)within 24 hours of onset who were hospitalized in the Department of Neurology,the First Affiliated Hospital of Xi’an Medical University from October 2019 to December 2020 were collected and divided into the wake-up stroke(WUS)group and the non-wake-up stroke(NWUS)group strictly according to the nadir criteria.WUS group and NWUS group were divided into 24 cases and 48 cases,and 29 physical examiners matched with the case group in terms of gender and age during the same period were the control group.Case data were collected from all study subjects and they were subdivided into different subgroups according to gender,previous medical history,site of cerebral infarction,infarct size,and presence of atherosclerotic plaque.2.Plasma melatonin levels were measured: all study subjects had plasma specimens retained in anticoagulation tubes at 2:00 a.m.and 8:00 a.m.the following morning.Plasma melatonin levels of each sample were measured by enzyme-linked immunoassay,the ratio of plasma melatonin levels at 2:00 to 8:00 hours was used to represent circadian rhythms.Changes in plasma melatonin levels and their circadian rhythms were compared between different groups,and the relationship between plasma melatonin levels and risk factors for cerebral infarction was analyzed.Data were processed using SPSS 26.0 statistical software.Results1.There were no statistically significant differences between the three groups for sex and age(P>0.05),whereas there were statistically significant differences between hypertension,diabetes mellitus,smoking,atherosclerotic plaque,and glycated hemoglobin(P<0.05);there were no significant differences between the WUS and NWUS groups in body mass index,past medical history,carotid atherosclerotic plaque,platelets,fasting glucose,glycated hemoglobin,total cholesterol,triglycerides,HDL,LDL,uric acid,homocysteine,infarct volume,or infarct site(P>0.05).2.Plasma melatonin levels were higher in the WUS group,NWUS group,and control group at 2 a.m.than at 8 a.m.in the same individual(P<0.01).3.Plasma melatonin levels were lower at 2 a.m.and 8 a.m.in both the WUS and NWUS groups than in the control group(P<0.01);melatonin levels were lower in the WUS group than in the NWUS group(P<0.05).4.Circadian rhythm was diminished in the WUS group compared with the control group(P<0.05);whereas there was no significant difference between the WUS and NWUS groups(P>0.05);and no statistical difference between the NWUS and control groups(P>0.05).5.There was a negative correlation between melatonin level and cerebral infarction occurrence(P<0.01)and a significant negative correlation with WUS(P<0.001);there was a negative correlation between alteration of circadian rhythm and WUS(P<0.001)and no correlation with NWUS(P>0.05).6.There were no statistical differences in melatonin levels and circadian rhythms between patients with different volumes of cerebral infarction(P>0.05).whereas melatonin levels differed between subgroups of patients with cerebral infarction at different sites,with patients with thalamic,parietal ventricular,and basal ganglia and parietal ventricular infarction having significantly lower melatonin levels at 2 a.m.compared with controls,and patients with basal ganglia and parietal ventricular infarction having significantly lower melatonin levels at 8 a.m.compared with controls were significantly reduced compared to controls(P<0.05).7.Plasma melatonin levels were higher in female patients than in male patients in the cerebral infarction and control groups(P<0.05).8.Melatonin levels were lower in patients with cerebral infarction without a history of hypertension than in those with a history of hypertension,and lower in those with atherosclerotic plaques than in those without plaques(P<0.05);while the differences with a history of diabetes,smoking,and alcohol consumption were not statistically significant(P>0.05).9.Plasma melatonin levels were negatively correlated with age,fasting glucose,glycosylated hemoglobin,and homocysteine(P<0.05).There were no significant correlated with body mass index,platelets,cholesterol,triglycerides,HDL-C,LDL-C,and uric acid(P>0.05).Conclusion1.Plasma melatonin levels decreased in patients with acute cerebral infarction and more significantly in patients with wake-up stroke;2.There is a marked circadian rhythm in the variation of plasma melatonin levels in humans,and the circadian rhythm of melatonin secretion is diminished in patients with wake-up stroke;3.Melatonin levels correlated with the site of cerebral infarction and decreased more significantly in patients with thalamic,paraventricular,basal ganglia region and paraventricular cerebral infarction;4.Hypertension,atherosclerotic plaque,age,fasting glucose,glycated hemoglobin,and homocysteine may have an effect on plasma melatonin levels.