Women Have a Lower Risk of Nonalcoholic Fatty Liver Disease but a Higher Risk of Progression vs Men: A Systematic Review and Meta-analysis.
Women Have a Lower Risk of Nonalcoholic Fatty Liver Disease but a Higher Risk of Progression vs Men: A Systematic Review and Meta-analysis.
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DOI：
10.1016/j.cgh.2020.04.067
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Kanwal F
中科院分区：
文献类型：
--
作者：
Balakrishnan M;Patel P;Dunn-Valadez S;Dao C;Khan V;Ali H;El-Serag L;Hernaez R;Sisson A;Thrift AP;Liu Y;El-Serag HB;Kanwal F
非酒精性脂肪性肝病（NAFLD）的风险及其进展可能在男性和女性之间存在差异。我们进行了一项系统性综述和荟萃分析，以确定性别与NAFLD、非酒精性脂肪性肝炎（NASH）和晚期NAFLD纤维化之间的关系。截至2017年12月，从MEDLINE、EMBASE和科克伦数据库中确定了报告基于人群样本的性别分层NAFLD患病率以及活检证实的NAFLD患者中的NASH或晚期纤维化的研究。我们计算了每个结果的女性与男性的合并相对风险比。我们的最终分析包括54项研究。NAFLD分析的样本量为62，239，NASH分析的样本量为5428，晚期纤维化分析的样本量为6444。在一般人群中，女性患NAFLD的风险比男性低19%（合并风险比[RR]，0.81; 95%CI，0.68-0.97; I2，97.5%）。与男性相比，女性的NASH风险相似（RR，1.00; 95% CI，0.88-1.14; I2，85.1%），晚期纤维化风险高37%（RR，1.37; 95% CI，1.12-1.68; I2，74.0%）。年龄改变了性别对NAFLD严重程度的影响。在平均年龄为50岁或以上的研究人群中，NASH（RR，1.17; 95% CI，1.01-1.36）和晚期纤维化（RR，1.56; 95% CI，1.36-1.80; I2=0）的风险在女性中显著较高; NASH和晚期纤维化的性别差异在年轻人群中减弱。在系统回顾和荟萃分析中，我们发现女性患NAFLD的风险低于男性。然而，一旦NAFLD确立，女性比男性有更高的晚期纤维化风险，特别是在50岁以后。
Risk of nonalcoholic fatty liver disease (NAFLD) and its progression may differ between men and women. We conducted a systematic review and meta-analysis to determine the relationship between sex and NAFLD, nonalcoholic steatohepatitis (NASH), and advanced NAFLD fibrosis Studies reporting sex-stratified NAFLD prevalence among population-based samples and either NASH or advanced fibrosis among patients with biopsy-proven NAFLD were identified from MEDLINE, EMBASE, and Cochrane databases through December 2017. We calculated pooled relative risk ratios comparing women vs men for each outcome. Our final analysis comprised 54 studies. Samples sizes were 62,239 for the NAFLD analysis, 5428 for the NASH analysis, and 6444 for the advanced fibrosis analysis. Women had a 19% lower risk of NAFLD than men in the general population (pooled risk ratio [RR], 0.81; 95% CI, 0.68–0.97; I2, 97.5%). Women had a similar risk of NASH (RR, 1.00; 95% CI, 0.88–1.14; I2, 85.1%) and 37% higher risk of advanced fibrosis (RR, 1.37; 95% CI, 1.12–1.68; I2, 74.0%) than men. Age modified the effect of sex on NAFLD severity. Risks of NASH (RR, 1.17; 95% CI, 1.01–1.36) and advanced fibrosis (RR, 1.56; 95% CI, 1.36–1.80; I2=0) were substantially higher in women in study populations with average ages of 50 year or more; sex differences in NASH and advanced fibrosis were attenuated in younger populations. In a systematic review and meta-analysis, we found women to have a lower risk of NAFLD than men. However, once NAFLD is established, women have a higher risk of advanced fibrosis than men—especially after age 50 years.
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