The Study Of Correlation Between Serum Melatonin Level And Vascular Calcification In Maintenance Hemodialysis Patients

Objective:This paper takes maintenance hemodialysis（MHD）patients as the main research object,analyzes the correlation between serum melatonin（MT）level and vascular calcification（VC）in MHD patients,so as to provide help for early detection of VC in MHD patients.Methods:A total of 85 patients receiving regular hemodialysis treatment in the Blood Purification Center of the Fourth Affiliated Hospital of China Medical University from January 2022 to August 2022 were selected as the research objects by the inclusion and exclusion criteria.All enrolled patients were examined by abdominal computed tomography（CT）to evaluate the degree of abdominal aortic calcification.To calculate the abdominal aortic calcification index^[1]（AACI）,according to the grading method of Nitta^[2],all patients were divided into the following four groups:AACI=0%for non-calcification group,AACI=1%-10%for mild calcification group,AACI=11%-30%for moderate calcification group,and AACI>30%for severe calcification group.To compare the levels of serum MT,clinical datas（age,gender,body mass index,blood pressure,dialysis age,history of coronary heart disease,history of diabetes）and laboratory indexes（serum creatinine,blood urea nitrogen,serum calcium,serum phosphorus,serum magnesium,uric acid,albumin,triglyceride,cholesterol,low density lipoprotein,alkaline phosphatase,hemoglobin,serum ferritin and parathyroid hormone）among the four groups.The risk factors or protective factors of VC were found by univariate and multivariate logistic regression analysis.ROC curve was used to explore the predictive value of MT on VC.Results:1.Among the 85 MHD patients,vascular calcification occurred in 65 cases（76.47%）.2.There was a significant difference in the MT level of MHD patients among the four groups（P<0.01）,and the MT level decreased with the increase of the degree of calcification.There were significant differences in the history of diabetes,age,dialysis age,systolic blood pressure,diastolic blood pressure,pulse pressure difference,serum calcium,serum phosphorus,low density lipoprotein and parathyroid hormone levels among the four groups（P<0.05）;The patient has diabetes,and with the increase of age,dialysis age,systolic pressure,diastolic pressure,pulse pressure difference,serum phosphorus,serum calcium,low density lipoprotein,and parathyroid hormone levels,the degree of calcification of the abdominal aorta is increasing.There was no significant difference in sex,history of coronary heart disease,body mass index,blood urea nitrogen,serum creatinine,uric acid,serum magnesium,albumin,triglyceride,cholesterol,alkaline phosphatase,hemoglobin and serum ferritin among the four groups（P>0.05）.3.Univariate logistic regression analysis showed that diabetes,age,dialysis age,systolic blood pressure,diastolic blood pressure,pulse pressure difference,serum calcium,serum phosphorus,low density lipoprotein,parathyroid hormone were risk factors for abdominal aortic calcification（P<0.05）.Melatonin was the protective factor of abdominal aortic calcification（P<0.05）.4.The results of multivariate logistic regression analysis showed that age（OR=1.064,95%CI=1.003-1.130,P=0.039）,dialysis age（OR=2.221,95%CI=1.458-3.380,P<0.001）,systolic blood pressure（OR=1.100,95%CI=1.031-1.174,P=0.004）,parathyroid hormone（OR=1.010,95%CI=1.003-1016,P=0.006）were independent risk factors for abdominal aortic calcification,and melatonin（OR=0.395,95%CI=0.237-0.660,P<0.001）was an independent protective factor for abdominal aortic calcification（P<0.001）.5.The ROC curve showed that the area under the curve of melatonin was 0.943[95%CI（0.892-0.995）,P<0.05],the best cut-off value is 17.760pg/m L,the Yoeden index was 0.788,the sensitivity was 85%,and the specificity was 93.8%.Conclusion:In maintenance hemodialysis patients,the incidence of vascular calcification is high.With the decrease of serum melatonin level,the severity of vascular calcification is increasing.Melatonin may be an independent protective factor for the occurrence of vascular calcification in maintenance hemodialysis patients,and may have some value in early prediction of vascular calcification.