评论:女人的肝脏和心脏

Jun Wang, Amedeo Lonardo
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摘要

这篇评论是关于Ren和Zheng最近的一项研究(Nutr Metab cardiovascular Dis. 2023;33:1349-1357)。这些作者分析了2000-2014年全国健康与营养调查中2627名非酒精性脂肪性肝病(NAFLD)成年人的性别分层的与全因和心血管领域结果相关的长期结果,并确定了美国脂肪肝指数(US FLI)评分。数据显示,与女性相比,男性面临的全因死亡率要高得多,而肥胖和2型糖尿病患者的风险最大。然而,年龄≤60岁的妇女死于心血管疾病(CVD)的风险更高。相反,60岁以上的女性与同年龄组的男性相比,没有观察到心血管疾病死亡风险的显著增加。Ren和Zheng的研究进一步促进了我们对心脏代谢危险因素的理解,说明了NAFLD中存在的性别差异。NAFLD对CVD的不同性别和年龄的影响表明,在患有NAFLD的年轻和中年妇女中,心脏代谢合并症可能被特别低估。Ren和Zhang的研究可能会刺激未来的研究,探索这些发现背后的分子和细胞基础,特别是包括纤维化NAFLD作为CVD的强大风险修饰因子的作用。总之,提高对肝脏和其他关键代谢器官中人体代谢的性别特异性调控的理解是在NAFLD领域实施精准医学方法的研究重点。
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Commentary: Of women, liver, and heart
This commentary is devoted to a recent study by Ren and Zheng (Nutr Metab Cardiovasc Dis. 2023;33:1349-1357). These authors analyzed sex-stratified long-term outcomes relevant to all-cause and cardiovascular field outcomes among 2,627 nonalcoholic fatty liver disease (NAFLD) adults enrolled in the 2000-2014 National Health and Nutrition Examination Surveys and identified with United States Fatty Liver Index (US FLI) score. Data have shown that, compared to women, men were exposed to a significantly higher all-cause mortality and the maximal risk was seen among those who had obesity and type 2 diabetes. However, women aged ≤ 60 years had a higher risk of death owing to cardiovascular disease (CVD). Conversely, no significantly increased risk of death from CVD was observed among women over 60 years compared to men of the same age group. The study by Ren and Zheng further fosters our understanding of cardiometabolic risk factors, illustrating sex differences present in NAFLD. The distinct impact of NAFLD on CVD by sex and age suggests that cardiometabolic comorbidities may be particularly underestimated among young and middle-aged women with NAFLD. The research by Ren and Zhang may stimulate future investigations exploring the molecular and cellular grounds underlying these findings, notably including the role of fibrosing NAFLD as a strong risk modifier of CVD. In conclusion, an improved understanding of sex-specific regulation of human metabolism in the liver and other key metabolic organs is a research priority finalized for implementing precision medicine approaches in NAFLD arena.
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