生物性别对炎症性肠病的影响。

Influence of biological sex in inflammatory bowel diseases.

作者信息

Tshikudi Diane M, Bernstein Charles N, Mishra Suresh, Ghia Jean-Eric, Armstrong Heather K

机构信息

Rady Faculty of Health Sciences, Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.

Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

Nat Rev Gastroenterol Hepatol. 2025 Feb 17. doi: 10.1038/s41575-025-01038-y.

DOI:10.1038/s41575-025-01038-y

PMID:39962330

Abstract

The incidence of inflammatory bowel disease (IBD) has risen in the past decades and has emerged as a global health issue. IBD is characterized by chronic inflammation of the gastrointestinal tract. There is compelling evidence for the role of biological sex in IBD epidemiology, pathophysiology, disease progression, symptoms and extra-intestinal diseases. IBD disease course, management and therapies differ between men and women, yet there is a paucity of analysis of sex as a factor. This Review discusses the known influence of sex-linked genetic factors, hormones and hormone receptors in IBD incidence, prevalence, disease burden and clinical manifestation. Furthermore, we review the mechanisms underlying these sex-dependent effects on the dysregulation of gastrointestinal mucosal immunity (immune, epithelial barrier and microbiota) in IBD. To support the progressive inclusion of sex in the study of IBD, we summarize the current standard research methodology that should be implemented to investigate sex as a biological variable in IBD studies. Enhanced comprehension of the influence of sex in IBD pathophysiology will advance the development of targeted therapies and improve patient care.

摘要

在过去几十年中，炎症性肠病（IBD）的发病率呈上升趋势，并已成为一个全球性的健康问题。IBD的特征是胃肠道的慢性炎症。有令人信服的证据表明，生物性别在IBD的流行病学、病理生理学、疾病进展、症状及肠外疾病中发挥作用。IBD的病程、管理和治疗在男性和女性之间存在差异，但将性别作为一个因素进行分析的情况却很少。本综述讨论了性连锁遗传因素、激素和激素受体在IBD发病率、患病率、疾病负担和临床表现方面的已知影响。此外，我们还综述了这些性别依赖性效应在IBD中对胃肠道黏膜免疫失调（免疫、上皮屏障和微生物群）的潜在机制。为支持在IBD研究中逐步纳入性别因素，我们总结了当前应采用的标准研究方法，以便在IBD研究中将性别作为一个生物学变量进行研究。增强对性别在IBD病理生理学中影响的理解将推动靶向治疗的发展并改善患者护理。