目的 探讨血清褪黑素（MT）、胰岛素样生长因子结合蛋白3（IGFBP3）水平对年龄相关性白内障（ARC）的诊断及预后评估价值。 方法 选取2023年10月至2025年1月在我院接受手术的ARC患者240例（ARC组），另选取同期体检健康者187例（对照组），采用酶联免疫吸附法检测血清MT、IGFBP3水平。根据6个月预后分为不良组和良好组，分析ARC患者预后的因素。ROC曲线血清MT、IGFBP3水平对ARC的诊断价值及预后评估价值。 结果 与对照组比较，ARC组血清MT水平降低，IGFBP3水平升高（P < 0.05）。血清MT、IGFBP3水平及二者联合诊断ARC的ROC曲线下面积分别为0.817、0.792、0.907，敏感度分别为76.67%、60.00%、83.75%，特异度分别为73.80%、85.03%、83.96%，二者联合的诊断价值优于血清MT、IGFBP3水平单独预测（P < 0.05）。240例ARC患者预后不良率为30.83%（74/240）。晶状体核硬度Ⅳ—Ⅴ级（OR = 4.632，95%CI：1.702 ~ 12.609，P = 0.003）、眼压升高（OR = 1.341，95%CI：1.123 ~ 1.601，P = 0.001）、IGFBP3升高（OR = 1.001，95%CI：1.001 ~ 1.002，P < 0.001）为ARC患者不良预后的独立危险因素，SFCT增加（OR = 0.978，95%CI：0.964 ~ 0.991，P = 0.001）、MT升高（OR = 0.667，95%CI：0.577 ~ 0.771，P < 0.001）为保护因素。血清MT、IGFBP3水平及二者联合评估ARC的ROC曲线下面积分别为0.836、0.821、0.919，敏感度分别为58.11%、91.89%、85.14%，特异度分别为92.77%、54.82%、83.73%，二者联合的评估价值优于血清MT、IGFBP3水平单独评估（P < 0.05）。 结论 ARC患者血清MT水平降低、IGFBP3水平升高与预后不良有关，二者联合对ARC的诊断价值和预后评估价值较高。

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.