A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease.
A longer duration of estrogen deficiency increases fibrosis risk among postmenopausal women with nonalcoholic fatty liver disease.
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DOI：
10.1002/hep.28514
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发表时间：
2016-07
期刊：
影响因子：
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通讯作者：
Nonalcoholic Steatohepatitis Clinical Research Network
中科院分区：
文献类型：
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作者：
Klair JS;Yang JD;Abdelmalek MF;Guy CD;Gill RM;Yates K;Unalp-Arida A;Lavine JE;Clark JM;Diehl AM;Suzuki A;Nonalcoholic Steatohepatitis Clinical Research Network
与绝经前女性相比，患有非酒精性脂肪性肝炎（NASH）的绝经后女性发生肝纤维化的风险增加。绝经后雌激素缺乏的持续时间是否决定了个体的纤维化风险仍有待研究。我们的目的是评估绝经年龄和绝经时间与绝经后非酒精性脂肪性肝病（NAFLD）妇女纤维化严重程度的关系。对488名绝经后妇女的数据进行了分析，这些妇女1）组织学诊断为NAFLD，2）自我报告绝经年龄。使用多序逻辑回归模型评估过早绝经（绝经年龄<40岁）和绝经时间（研究入组时的年龄-绝经年龄，年）与纤维化严重程度（0-4期）的相关性，调整和不调整临床混杂因素。在参与者中（绝经年龄：43.7 ± 8.6岁），过早绝经的妇女（29.3%）在入组时更年轻（p<0.001），更经常使用激素替代疗法（HRT）（p<0.003）。在调整入组时的年龄、种族、体重指数标准化腰围、当前吸烟、当前饮酒、高血压、糖尿病/空腹血糖受损、胰岛素抵抗的稳态模型评估和HRT后，过早绝经与更严重纤维化的可能性增加相关;校正的累积比值比和95%置信区间（ACOR [95%CI]）为1.9 [1.3-2.7]，p=0.001，而绝经时间与更严重纤维化的可能性增加直接相关，（5年单位的ACOR [95%CI]=1.2 [1.1-1.3]，p=0.002）。绝经后状态下雌激素缺乏的持续时间赋予绝经后NAFLD妇女纤维化风险
Post-menopausal women with nonalcoholic steatohepatitis (NASH) are at an increased risk of hepatic fibrosis when compared with premenopausal women. Whether duration of estrogen deficiency in postmenopausal state dictates individual’s fibrosis risk remains uninvestigated. We aimed to assess the associations of age at menopause and time from menopause with fibrosis severity in postmenopausal women with nonalcoholic fatty liver disease (NAFLD). Data from 488 post-menopausal women with 1) histologic diagnosis of NAFLD and 2) self-reported information on age at menopause were analyzed. The associations of premature menopause (age at menopause of <40 years) and time from menopause (age at study enrollment - age at menopause, years) with fibrosis severity (stage 0–4) were assessed using multiple ordinal logistic regression models with and without adjusting for clinical confounders. Among the participants (age at menopause: 43.7 ± 8.6 years), women with premature menopause (29.3 %) were younger at enrollment (p<0.001) and used hormone replacement therapy (HRT) more often (p<0.003). After adjusting for age at enrollment, race, waist circumference standardized by body mass index, current smoking, current alcohol use, hypertension, diabetes/impaired fasting glucose, homeostatic model assessment of insulin resistance, and HRT, premature menopause was associated with an increased likelihood of having more severe fibrosis; adjusted cumulative odds ratio and 95% confidence interval (ACOR [95%CI]) was 1.9 [1.3–2.7], p=0.001, while time from menopause was directly associated with an increased likelihood of having more severe fibrosis (ACOR [95%CI] for 5-year unit=1.2 [1.1–1.3], p=0.002). Duration of estrogen deficiency in postmenopausal state confers fibrosis risk among post-menopausal women with NAFLD.