目的：探讨血清沉默信息调节因子(Sirts)1-6水平与氧化应激指标的关系及其对年龄相关性白内障(ARC)发生的诊断价值。

方法：前瞻性选取2019年6月至2021年7月于本院收治的ARC患者为研究对象，另选择同期本院年龄相匹配的体检健康者作为对照组。对比两组参与者一般资料； 比较两组参与者血清Sirt1-6表达水平以及氧化应激指标\〖丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、总抗氧化能力(TAC)\〗水平； 采用Pearson相关法分析血清Sirt1-6表达水平与氧化应激指标之间的相关性； 采用多因素Logistic回归模型分析ARC发生的影响因素； 采用受试者工作特征(ROC)曲线评估血清Sirt1-6表达水平以及氧化应激指标对ARC的诊断价值。

结果：纳入ARC患者127例，其中男68例，女59例，平均年龄66.05±2.58岁； 同期对照组121例，男63例，女58例，平均年龄65.54±2.86岁； ARC组血清Sirt1、3、6表达水平、SOD、GSH-Px以及TAC表达水平均明显低于对照组(均P<0.001)，MDA水平明显高于对照组(P<0.001)； Pearson相关性分析结果显示，ARC组血清Sirt1、Sirt3、Sirt6水平与SOD、GSH-Px以及TAC呈正相关，与MDA呈负相关； 多因素分析结果显示，血清Sirt1、Sirt6水平以及MDA、SOD、GSH-Px均与ARC发生显著相关(均P<0.01)。ROC结果显示，血清Sirt1、Sirt6以及MDA、SOD、GSH-Px联合诊断ARC的AUC为0.995，明显高于Sirt1(Z=4.978，P<0.001)、Sirt6(Z=7.487，P<0.001)、MDA(Z=6.449，P<0.001)、SOD(Z=5.773，P<0.001)、GSH-Px(Z=5.056，P<0.001)单独使用时的AUC(P<0.05)。

结论：ARC患者血清中Sirt1、3、6水平普遍降低，且与氧化应激失衡密切相关； 其中，血清Sirt1和Sirt6水平降低及氧化应激指标(MDA升高，SOD、GSH-Px降低)是ARC发生的影响因素，且这些指标联合检测对ARC具有极高的诊断价值。

METHODS:A prospective cohort of ARC patients admitted to the hospital between June 2019 and July 2021 was enrolled as the study subjects. Concurrently, age-matched healthy individuals undergoing routine physical examinations at the hospital during the same period were recruited as the control group. Baseline demographic and clinical characteristics were compared between the two groups. Serum levels of Sirt1-6 and oxidative stress markers including malondialdehyde(MDA), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px), and total antioxidant capacity(TAC)were compared. Pearson correlation analysis was performed to assess the associations between serum Sirt1-6 levels and oxidative stress parameters. Multivariate Logistic regression analysis was conducted to analysis risk factors associated with ARC occurrence. Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum Sirt1-6 levels and oxidative stress indicators for ARC.

RESULTS: The study included 127 ARC patients, comprising 68 men and 59 women, with a mean age of 66.05±2.58 y; the concurrent control group consisted of 121 patients, comprising 63 men and 58 women, with a mean age of 65.54±2.86 y. Serum levels of Sirt1, 3 and 6, SOD, GSH-Px, and TAC were significantly lower in the ARC group compared to the control group(all P<0.001), whereas MDA levels were markedly elevated(P<0.001). Pearson correlation analysis revealed that serum levels of Sirt1, Sirt3, Sirt6 in the ARC group were positively correlated with SOD, GSH-Px, and TAC, and negatively correlated with MDA. Multivariate Logistic regression analysis demonstrated that serum Sirt1, Sirt6, MDA, SOD, and GSH-Px were significantly associated with the occurrence of ARC(all P<0.001). ROC curve analysis showed that the combination of Sirt1, Sirt6, MDA, SOD, and GSH-Px yielded an area under the curve(AUC)of 0.995 for diagnosing ARC, which was significantly higher than that of Sirt1 alone(Z=4.978,P<0.001), Sirt6 alone(Z=7.487,P<0.001), MDA alone(Z=6.449,P<0.001), SOD alone(Z=5.773,P<0.001), or GSH-Px alone(Z=5.056,P<0.001), indicating superior diagnostic accuracy of the multimarker panel(P<0.05).

CONCLUSION: Serum levels of Sirt1, 3, and 6 are generally reduced in ARC patients and are closely associated with oxidative stress imbalance. Specifically, decreased serum levels of Sirt1 and Sirt6, along with oxidative stress markers(elevated MDA and reduced SOD and GSH-Px)are identified as risk factors for ARC. Moreover, the combined detection of these indicators presents high diagnostic value for ARC.