尿戊糖苷作为骨健康受损的潜在生物标志物：一项系统评价和荟萃分析。
Urinary pentosidine as a potential biomarker of impaired bone health: a systematic review and meta-analysis.
作者信息
Shirinezhad Amirhossein, Azarboo Alireza, Mafhoumi Asma, Islampanah Muhammad, Mohammadi Sara, Ghaseminejad-Raeini Amirhossein, Hoveidaei Amir Human
机构信息
School of Medicine, Tehran University of Medical Sciences, District 6, Pour Sina St, P94V+8MF, Tehran, Tehran Province Iran.
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
J Diabetes Metab Disord. 2024 Dec 16;24(1):6. doi: 10.1007/s40200-024-01515-2. eCollection 2025 Jun.
BACKGROUND
Urinary pentosidine, an advanced glycation end product (AGE), has been proposed as a potential biomarker for impaired bone health, especially in older adults and those with diabetes. This study aimed to systematically review and meta-analyze the association of urinary pentosidine with bone mineral density (BMD) and fracture risk.
METHODS
A comprehensive search of Embase, PubMed, Scopus, and Web of Science databases was conducted and records were gathered from 1960 to February 2024. Relevant papers were screened and data were extracted by two independent reviewers. Hedges' g standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated to compare urinary pentosidine levels between patients with and without fractures.
RESULTS
A total of 12 studies comprising 5,878 participants were included in the systematic review. The meta-analysis revealed that patients with fractures had significantly higher urinary pentosidine levels compared to those without fractures (SMD [95% CI] = 0.53 [0.39-0.68]; I² = 54%; < 0.01). In patients with vertebral fractures, pentosidine levels were also elevated (SMD [95% CI] = 0.51 [0.32-0.70]; I² = 64%; < 0.01). Additionally, some studies demonstrated that an increase in urinary pentosidine was significantly associated with fracture risk (aHR = 1.20 [95% CI = 1.07-1.33]; = 0.001) and BMD reduction (β = -0.125 [95% CI = -0.248, -0.002]; = 0.047). However, other studies showed inconsistent results, particularly regarding the association between pentosidine and BMD or fracture risk in non-diabetic populations (aRR [95%CI] = 1.08 [0.79-1.49]; = 0.6). Diagnostic accuracy analyses revealed a sensitivity of 71.9% and specificity of 61.2% for urinary pentosidine in predicting vertebral fracture in patients with type 2 diabetes mellitus.
CONCLUSION
This systematic review and meta-analysis demonstrate that elevated urinary pentosidine levels are associated with an increased risk of fractures and, to a lesser extent, reduced bone mineral density. Its diagnostic accuracy improves when integrated with other clinical markers, such as BMD and bone turnover indices. However, due to the variability in results, further research is needed to standardize pentosidine's use as a reliable biomarker for impaired bone health in clinical practice.
背景
尿戊糖苷是一种晚期糖基化终产物（AGE），已被提议作为骨健康受损的潜在生物标志物，尤其是在老年人和糖尿病患者中。本研究旨在系统评价和荟萃分析尿戊糖苷与骨密度（BMD）及骨折风险之间的关联。
方法
对Embase、PubMed、Scopus和Web of Science数据库进行全面检索，收集1960年至2024年2月的记录。由两名独立评审员筛选相关论文并提取数据。计算Hedges' g标准化平均差（SMD）和95%置信区间（CI），以比较有骨折和无骨折患者的尿戊糖苷水平。
结果
系统评价共纳入12项研究，涉及5878名参与者。荟萃分析显示，与无骨折患者相比，骨折患者的尿戊糖苷水平显著更高（SMD [95% CI] = 0.53 [0.39 - 0.68]；I² = 54%；P < 0.01）。在椎体骨折患者中，戊糖苷水平也升高（SMD [95% CI] = 0.51 [0.32 - 0.70]；I² = 64%；P < 0.01）。此外，一些研究表明，尿戊糖苷升高与骨折风险显著相关（aHR = 1.20 [95% CI = 1.07 - 1.33]；P = 0.001）和骨密度降低相关（β = -0.125 [95% CI = -0.248, -0.002]；P = 0.047）。然而，其他研究结果不一致，特别是关于非糖尿病人群中戊糖苷与骨密度或骨折风险之间的关联（aRR [95%CI] = 1.08 [0.79 - 1.49]；P = 0.6）。诊断准确性分析显示，尿戊糖苷在预测2型糖尿病患者椎体骨折方面的敏感性为71.9%，特异性为61.2%。
结论
本系统评价和荟萃分析表明，尿戊糖苷水平升高与骨折风险增加相关，在较小程度上与骨密度降低相关。与其他临床标志物（如骨密度和骨转换指标）结合使用时，其诊断准确性会提高。然而，由于结果存在变异性，需要进一步研究以规范戊糖苷在临床实践中作为骨健康受损可靠生物标志物的应用。
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