Division of Kidney, Urology and Hematology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Mayo Clin Proc. 2020 Mar;95(3):587-599. doi: 10.1016/j.mayocp.2019.08.026.
While the global prevalence of both type 1 and type 2 diabetes mellitus is similar in men and women, the consequences of diabetes on associated end-organ complications, including diabetic kidney disease appear to be more sex-specific. Particularly, women with diabetes have higher mortality rates for diabetes-related deaths, and higher prevalence of diabetic kidney disease risk factors such as hypertension, hyperglycemia, obesity, and dyslipidemia. However, the evidence for the impact of sex on diabetic kidney disease prevalence and disease progression is limited and inconsistent. Although most studies agree that the protective effect of the female sex against the development of kidney disease is diminished in the setting of diabetes, the reasons for this observation are unclear. Whether or not sex differences exist in the risk of diabetic kidney disease is also unclear, with studies reporting either higher risk in men, women, or no sex differences. Despite the remaining controversies, some of the factors that associate with sex differences in the risk of diabetic kidney disease are age at onset, and type and duration of diabetes. There is growing appreciation of the importance of sex hormones in the regulation of renal function, with estrogens generally considered to be renoprotective. Although some progress has been made towards better understanding of the mechanisms by which sex hormones play a role in the pathophysiology of diabetic kidney disease, the translational potential of this knowledge is still underappreciated. A better understanding of sex differences in diabetic kidney disease may provide basis for personalized and sex-specific treatment of diabetic kidney disease.
虽然 1 型和 2 型糖尿病在男性和女性中的全球患病率相似，但糖尿病对相关终末器官并发症的影响，包括糖尿病肾病，似乎更具性别特异性。特别是，女性糖尿病患者的糖尿病相关死亡率更高，且高血压、高血糖、肥胖和血脂异常等糖尿病肾病危险因素的患病率更高。然而，关于性别对糖尿病肾病患病率和疾病进展影响的证据有限且不一致。尽管大多数研究都认为，女性对肾脏疾病的保护作用在糖尿病患者中会减弱，但这一观察结果的原因尚不清楚。是否存在糖尿病肾病风险的性别差异也不清楚，一些研究报告男性、女性或无性别差异的风险更高。尽管仍存在争议，但一些与糖尿病肾病风险性别差异相关的因素包括发病年龄、糖尿病类型和病程。人们越来越认识到性激素在调节肾功能中的重要性，雌激素通常被认为具有肾脏保护作用。尽管在更好地理解性激素在糖尿病肾病病理生理学中发挥作用的机制方面已经取得了一些进展，但对这方面知识的转化潜力仍认识不足。更好地了解糖尿病肾病中的性别差异可能为糖尿病肾病的个体化和性别特异性治疗提供基础。
