背景:晚期糖基化终产物(AGE),糖尿病终末器官损害的主要因素之一,积累在长半衰期的蛋白质中,如皮肤和软骨胶原蛋白。AGE测量可能为预测糖尿病血管并发症提供额外的证据。皮肤自发荧光(SAF)被认为是一种非侵入性的,快,和可靠的方法来测量组织AGE水平。这项研究的目的是回顾和评估糖尿病(DM)患者SAF测量的临床验证证据。
方法:在本系统综述和荟萃分析中,我们从"PubMed"(MEDLINE)和"Cochrane"数据库开始至2021年8月10日搜索了关于糖尿病患者SAF测量的观察性研究.高级搜索中使用了以下关键术语:“糖尿病”,“糖尿病”,\"DM\",\"糖化\",“高级糖基化终产物”,“年龄”,“皮肤自发荧光”,\"SAF\"。包括DM患者并使用SAF评估其AGE的已发表研究被认为符合荟萃分析的条件。是社论的文章,研究提案,国会海报,或病例报告,并不在人类受试者被排除。我们使用随机效应模型对SAF在DM中的临床验证进行荟萃分析,特别强调慢性糖尿病并发症。
结果:我们确定了881条记录,29条记录符合我们的资格标准,并纳入系统评价和荟萃分析。在具有实质性异质性的研究中,SAF与糖尿病末级HbA1c0.21(0.13,0.28)之间存在统计学上的显着相关性(I2=77.99%,p<0.05)。然而,SAF水平与糖尿病视网膜病变(DR)之间存在显着正相关[(OR=1.05,95%CI=1.03,1.08),(I2=63.78%,p<0.05)],糖尿病周围神经病变(DPN)[(OR=1.11,95CI=1.06,1.16),(I2=79.17%,p<0.05)],糖尿病肾病(DNP)[(OR=1.08,95CI:1.05,1.11),(I2=65.36%,p<0.05)]和糖尿病大血管事件(D-MVE)[(OR=1.08,95CI=1.05,1.11)(I2=67.32,p<0.05)]。
结论:我们的研究证实了SAF测量作为DM微血管和大血管并发症的非侵入性替代标志物的重要性。皮肤AGE估计可能是预测和早期发现不可逆DM并发症的有用因素。需要更多的研究人群和更长的随访期。
BACKGROUND: Advanced glycation end products (AGE), one of the main factors causing diabetic end-organ damage, accumulate in long half-life proteins, such as skin and cartilage collagen. AGE measurement may offer additional evidence to predict diabetic vascular complications. Skin autofluorescence (SAF) is suggested as a non-invasive, quick, and reliable method to measure tissue AGE level. The aim of this study was to
review and evaluate evidence on the clinical validation of SAF measurement in diabetes mellitus (DM) patients.
METHODS: In this systematic
review and meta-analysis, we searched \"PubMed\" (MEDLINE) and \"Cochrane\" databases from their inception to 10 August 2021 for observational studies concerning SAF measurement in diabetic patients. The following key terms were used in advanced searching: \"Diabetes\", \"Diabetes Mellitus\",\" DM\", \"Glycation \", \"Advanced Glycation End product\", \"AGE\", \"skin autofluorescence\", \"SAF\". Published studies that included DM patients and estimated their AGE using SAF were considered eligible for meta-analysis. Articles that were editorials, study proposals, congress posters, or case reports and were not on human subjects were excluded. We used a random-effect models for meta-analyzing the clinical validation of SAF in DM with particular emphasis on chronic diabetes complications.
RESULTS: We identified 881 records and twenty-nine records fulfilled our eligibility criteria and were included in the systematic
review and meta-analysis. A statistically significant correlation was found between SAF and diabetes last HbA1c 0.21(0.13,0.28) in studies with substantial heterogeneity (I2=77.99%, p<0.05). Nevertheless, a significant positive association between SAF level and diabetic retinopathy (DR) [(OR= 1.05, 95% CI=1.03,1.08), (I2=63.78%, p<0.05)], diabetic peripheral neuropathy (DPN) [(OR= 1.11, 95%CI= 1.06,1.16), (I2=79.17%, p<0.05)], diabetic nephropathy (DNP) [(OR= 1.08, 95%CI: 1.05,1.11), (I 2 =65.36%, p<0.05)] and diabetic macrovascular events (D-MVE) [(OR=1.08, 95%CI=1.05,1.11) (I2=67.32, p<0.05)] were found.
CONCLUSIONS: Our study confirmed the significance of SAF measurement as a non-invasive surrogate marker of DM micro and macrovascular complications. Skin AGE estimation may be a useful factor for the prediction and early detection of irreversible DM complications. More studies with larger populations and longer follow-up periods are required.