Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Apr;96(4):1006-1016. doi: 10.1016/j.mayocp.2020.08.020. Epub 2021 Mar 10.
Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differences in alcohol metabolism that may account for this discrepancy between men and women, and sex differences in treatment enrollment and response. Studies were identified by performing a literature search of PubMed and Google Scholar and through review of the references in retrieved articles. Search terms included alcohol-associated liver disease, alcoholic hepatitis, alcoholic cirrhosis, sex, gender, female, epidemiology, bariatric surgery, obesity, treatment. Due to the paucity of literature on some of the relevant subject matter and inclusion of landmark studies, no date range was selected. Studies were included if their methods were sufficiently robust and they made a comparison between the sexes that is clinically relevant. Understanding of the changing epidemiology and mechanisms of liver disease development unique to women are paramount in creating appropriate and effective interventions for women who represent a rapidly growing subset of patients with alcohol-associated liver disease.
在美国，酒精相关性肝病的发病率日益增高。既往认为，酒精相关性肝病更常见于男性，而女性发病率较低；但目前这种性别差异正在逐渐缩小。研究表明，女性在摄入较少酒精量的情况下就可能发生肝病，且其疾病严重程度较男性更重。本文综述了女性中酒精相关性肝病发病率不断增高的原因，包括肥胖和减重手术等导致饮酒模式和肝病发生发展的变化的原因，可能导致男女之间差异的酒精代谢的性别特异性差异的相关机制，以及治疗参与和反应的性别差异。通过对 PubMed 和 Google Scholar 进行文献检索，并查阅检索到的文章中的参考文献，确定了研究。检索词包括酒精相关性肝病、酒精性肝炎、酒精性肝硬化、性别、性别、女性、流行病学、减重手术、肥胖、治疗。由于一些相关主题的文献较少，且包含了一些里程碑式的研究，因此未选择特定的时间范围。如果研究方法足够可靠，且对性别之间具有临床相关性的差异进行了比较，则将其纳入。了解女性特有的肝病发病机制和流行病学变化对于为代表着酒精相关性肝病患者中快速增长的亚组的女性制定适当和有效的干预措施至关重要。
