关键词: 年龄相关性白内障, 褪黑素, 胰岛素样生长因子结合蛋白3, 诊断, 预后

Abstract:

Objective To investigate the diagnostic and prognostic value of serum melatonin （MT） and insulin-like growth factor binding protein 3 （IGFBP3） levels in patients with age-related cataract （ARC）. Methods This study enrolled 240 ARC patients who underwent surgery at our hospital from October 2023 to January 2025 as the ARC group， and 187 healthy individuals undergoing physical examinations during the same period as the control group. Serum MT and IGFBP3 levels were measured using enzyme-linked immunosorbent assay. Based on a 6-month postoperative follow-up， ARC patients were stratified into good and poor prognosis groups for prognostic factor analysis. Receiver operating characteristic （ROC） curves were used to evaluate the diagnostic and prognostic performance of serum MT， IGFBP3， and their combination. Results Compared with the control group， ARC patients exhibited significantly lower serum MT levels and higher IGFBP3 levels （P < 0.05）. For diagnosing ARC， the area under the ROC curve （AUC） was 0.817 for MT， 0.792 for IGFBP3， and 0.907 for their combination， with corresponding sensitivities of 76.67%， 60.00%， and 83.75%， and specificities of 73.80%， 85.03%， and 83.96%. The combined detection demonstrated superior diagnostic performance compared with either marker alone （P < 0.05）. The poor prognosis rate among ARC patients was 30.83% （74/240）. Multivariate logistic regression identified lens nuclear hardness grade Ⅳ—Ⅴ （OR = 4.632， 95%CI： 1.702 - 12.609， P = 0.003）， elevated intraocular pressure （OR = 1.341， 95%CI： 1.123 ~ 1.601， P = 0.001）， and increased IGFBP3 levels （OR = 1.001， 95%CI： 1.001 - 1.002， P < 0.001） as independent risk factors for poor prognosis. Conversely， greater subfoveal choroidal thickness （OR = 0.978， 95%CI： 0.964 - 0.991， P = 0.001） and higher MT levels （OR = 0.667， 95%CI： 0.577 - 0.771， P < 0.001） were independent protective factors. For prognostic evaluation， the AUCs were 0.836 for MT， 0.821 for IGFBP3， and 0.919 for their combination， with sensitivities of 58.11%， 91.89%， and 85.14%， and specificities of 92.77%， 54.82%， and 83.73%， respectively. The combined evaluation showed superior predictive value compared with either marker alone （P < 0.05）. Conclusion Decreased serum MT and elevated IGFBP3 levels are associated with ARC and its poor prognosis. The combined assessment of both biomarkers provides higher diagnostic accuracy and prognostic predictive value for ARC.

Key words: age-related cataract, melatonin, insulin-like growth factor binding protein 3, diagnosis, prognosis