Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI.
Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
Chest. 2022 Sep;162(3):647-658. doi: 10.1016/j.chest.2022.03.006. Epub 2022 Mar 14.
The terms sex and gender often are used interchangeably, but have specific meaning when it comes to their effects on lung disease. Ample evidence is now available that sex and gender affect the incidence, susceptibility, presentation, diagnosis, and severity of many lung diseases. Some conditions are more prevalent in women, such as asthma. Other conditions are seen almost exclusively in women, like lymphangioleiomyomatosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as higher number of exacerbations experienced by women with COPD and greater cardiovascular morbidity in women with sleep-disordered breathing. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors often are not addressed adequately in clinical trials. Various aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for women. This article is a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of lung diseases. Pathobiological mechanisms explaining sex differences in these diseases are beyond the scope of this article. We review the literature and focus on recent guidelines about using sex and gender in research. We also review sex and gender differences in lung diseases.
性别和性常常可以互换使用，但在涉及它们对肺部疾病的影响时，它们具有特定的含义。现在有大量证据表明，性别和性会影响许多肺部疾病的发病率、易感性、表现、诊断和严重程度。有些疾病在女性中更为常见，例如哮喘。其他疾病几乎只在女性中出现，例如淋巴管肌瘤病。一些生命阶段——例如怀孕——是女性特有的，会影响肺部疾病的发生和病程。临床表现也可能不同，例如 COPD 女性的恶化次数更多，睡眠呼吸障碍女性的心血管发病率更高。此外，治疗反应和药物安全性也可能因性别而异，但药物基因组学因素在临床试验中往往没有得到充分解决。肺部和睡眠生物学和病理生物学的各个方面都受到女性性别和女性生殖过渡的影响。这些生物学差异可能会影响基因表达或器官发育。了解这些差异是迈向女性精准医学的第一步。本文是一篇关于性别和性对肺部疾病的流行病学、表现、危险因素和管理的具体影响的最新综述。本文不涉及解释这些疾病中性别差异的病理生物学机制。我们回顾了文献，并重点介绍了关于在研究中使用性别的最新指南。我们还综述了肺部疾病中的性别差异。
