目的：通过对中老年白内障患者的外周血多项检验指标的大样本多因素Logistic综合分析，探讨与疾病潜在相关性的检验指标变化特点，以研究中老年白内障的发病机制。方法采用回顾性病例对照研究。收集2011年6月至2015年7月在复旦大学附属眼耳鼻喉科医院确诊为白内障的患者，对3527例白内障患者，平均年龄为（64．47±11．29）岁，其中男性1804例，女性1723例；开展了以下14项外周血检验，即外周血白蛋白（albumin，ALB）、球蛋白（globulin，GLB）、总蛋白（total protein，TP）、血糖（blood glucose，GLU）、尿素氮（blood urea nitrogen，BUN）、尿酸（uric acid，URCA）、肌酐（creatinine，Cr）、乳酸脱氢酶（lactic dehydrogenase，LDH）、碱性磷酸酶（alkaline phosphatase，ALP）、钙离子（calcium，Ca）、钠离子（sodium，Na）、钾离子（kalium，K）、氯离子（chlorine，Cl）和磷离子（ phosphorus ，P）。检测的病例，由LIS（实验室信息系统）系统采集上述14项指标的数据。通过严格筛选本院非白内障的住院患者作为此次研究的对照组，共3333例，平均年龄为（64．04±9．03）岁，其中男性1770例，女性1563例。采用独立样本t检验及多因素Logistic回归分析对白内障组与对照组间的上述生化指标进行分析。同时，按年龄（40～59岁，60～79岁，80岁及以上）将白内障患者分为3个亚组，分别与对照组进行独立样本t检验统计学分析。结果两组间年龄（ t＝1．663，P＝0．096）和性别（t＝2．63，P＝0．105）间差异均无统计学意义。白内障组与对照组间Logistic回归分析显示，ALB （OR＝1．053，95％CI＝1．019～1．088）、BUN （OR＝1．113，95％CI＝1．076～1．152）、Cr （OR＝1．007，95％CI＝1．003～1．010）、GLB（OR＝1．049，95％ CI＝1．018～1．081）、GLU（OR＝1．175，95％ CI＝1．139～1．211）、Cl（OR＝1．059，1．032～1．088）、Na（OR＝1．180，95％CI＝1．150～1．212）与白内障的发生发展存在相关性（P＜0．05）。白内障不同年龄组间血液生化指标分析显示，40～59岁年龄组，白内障组外周血ALB、GLU、Na、Cl 水平高于对照组（t＝8．780，t＝4．670，t＝9．695，t＝6．415；P均＜0．05）；60～79岁年龄组，白内障组外周血ALB、BUN、Cr、GLU、Na、Cl水平高于对照组（ t＝4．974，t＝9．414，t＝4．123，t＝6．906，t＝14．741，t＝9．212；P均＜0．05）；80岁及以上年龄组，白内障组外周血BUN、Cr、GLU、Na、Cl 水平高于对照组（ t＝6．077， t＝4．906， t＝2．626， t＝5．459， t＝3．424；P＜均0．05）。结论中老年白内障患者外周血中ALB、BUN、GLB、Cr、GLU、Na、Cl水平均显著升高，这些变化可能不同程度与白内障病变相关。（中华检验医学杂志，2016，39：448－453）%Objective A large sample of multi-factor Logistic analysis of clinical biochemical indicators from elderly cataract patients were done to find the characteristics of possible changes in potential factors for cataract-related indicators and explore the pathogenesis of cataract from the perspective of laboratory diagnosis.Methods A retrospective case control study was conducted .Cataract patients from Eye-Ear Nose Throat Hospital of Fudan University were collected during June 2011 to July 2015 and routinely tested for 14 clinical biochemistry indicators including ALB , GLU, TP, GLB, BUN, URCA, Cr, LDH, ALP, Ca, Na, K, Cl, and P.The mean age of the 3 527 cataract patients (1 804 males, 1 723 females) was (64.47 ±11.29) years.Those data were reserved by LIS (Laboratory Information System) system and were retrieved for large data analysis . The control group was filtered from hospitalized patients besides cataract patients during January 2014 to July 2015.The mean age of the 3 333 control subjects ( 1 770 males, 1 563 females ) was ( 64.04 ±9.03 ) years.Biochemical indicators between cataract group and control group were analyzed by independent student′s t-test and Logistic regression .Meanwhile , the objects were divided into 3 groups according to the age (40-59 years,60-79 years,≥80 years) for independent student′s t-test with the control group respectively .Results There are no statistical difference in age ( t=1.663,P=0.096) and gender ( t=2.63,P=0.105 0) between cataract group and control group ( P>0.05).The results of Logistic regression between cataract group and control group were as follow : ALB (OR=1.053,95%CI=1.019-1.088),BUN(OR=1.113,95% CI=1.076-1.152),Cr(OR=1.007, 95%CI=1.003-1.010),GLB(OR=1.049,95% CI=1.018 -1.081),GLU(OR=1.175,95% CI=1.139-1.211),Cl(OR=1.059,1.032 -1.088),Na(OR=1.180,95% CI =1.150 -1.212).Those might be enrolled as risk factors for cataract (P<0.05).The level of ALB, GLU, Na and Cl in cataract group according to different age groups were significantly higher ( t=8.780,t=4.670, t=9.695, t=6.415, P<0.05) than that of control in 40-59 age group;the level of ALB, BUN, Cr, GLU, Na and Cl in cataract group was significantly higher ( t=4.974, t=9.414, t=4.123, t=6.906, t=14.741, t=9.212, P<0.05) than control in 60 -79 age group; the level of BUN, Cr, GLU, Na and Cl in cataract group was significantly higher (t=6.077, t=4.906, t=2.626, t=5.459, t=3.424, P<0.05) than control in 80-age group.Conclusions The level of ALB, BUN, GLB, Cr, GLU, Na and Cl in peripheral blood of cataract patients was significantly increased which suggested that those change might associated with the pathogenesis of cataract .
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