Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes.
Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes.
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结核病发病机制和治疗结果的性别差异。
DOI：
10.1007/978-3-031-35139-6_6
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发表时间：
2023
影响因子：
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通讯作者：
Bishai,WilliamR
中科院分区：
文献类型：
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作者：
Dabitao,Djeneba;Bishai,WilliamR
结核病仍然是世界许多国家令人畏惧的公共卫生问题。全球结核病流行病学的一致观察结果是，与女性相比，男性活动性肺结核病例较多。来自人类和动物的数据还表明，男性比女性更容易患上活动性肺部疾病。同样，男性也与不良的治疗结果有关。尽管证据不断增加，但人们对结核病性别偏见的驱动机制知之甚少。已提出两个主要假设来解释男性中活动性肺结核的流行。第一个是基于生物因素，如性激素和遗传因素，在结核病期间对宿主免疫力的贡献。第二个重点是非生物因素，例如吸烟、职业暴露和寻求健康的行为，这些因素都受到性别的影响。在本章中，我们通过介绍人类和实验动物研究来回顾有关这两种流行假设的文献。此外，我们还提出了旨在检查性别和性别对其他临床形式结核病（例如潜伏性结核感染和肺外结核）的影响的研究，这两种结核病似乎都有其与性别相关的特殊性。我们还强调了结核病背景下性别之间的潜在交叉点，并分享了未来的方向，这些方向可以指导阐明结核病发病机制和治疗结果中基于性别的差异的机制。
Tuberculosis remains a daunting public health concern in many countries of the world. A consistent observation in the global epidemiology of tuberculosis is an excess of cases of active pulmonary tuberculosis among males compared with females. Data from both humans and animals also suggest that males are more susceptible than females to develop active pulmonary disease. Similarly, male sex has been associated with poor treatment outcomes. Despite this growing body of evidence, little is known about the mechanisms driving sex bias in tuberculosis disease. Two dominant hypotheses have been proposed to explain the predominance of active pulmonary tuberculosis among males. The first is based on the contribution of biological factors, such as sex hormones and genetic factors, on host immunity during tuberculosis. The second is focused on non-biological factors such as smoking, professional exposure, and health-seeking behaviors, known to be influenced by gender. In this chapter, we review the literature regarding these two prevailing hypotheses by presenting human but also experimental animal studies. In addition, we presented studies aiming at examining the impact of sex and gender on other clinical forms of tuberculosis such as latent tuberculosis infection and extrapulmonary tuberculosis, which both appear to have their own specificities in relation to sex. We also highlighted potential intersections between sex and gender in the context of tuberculosis and shared future directions that could guide in elucidating mechanisms of sex-based differences in tuberculosis pathogenesis and treatment outcomes.