不同年龄段女性非酒精性脂肪肝的病程特点:文献综述

I. Bulatova, T. P. Shevlyukova
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摘要

本综述探讨了女性非酒精性脂肪肝(NAFLD)的流行病学和风险因素。据各种资料显示,非酒精性脂肪肝在全球成年人口中的发病率为20%至40%。在俄罗斯,37.3%的综合医院患者患有非酒精性脂肪肝。非酒精性脂肪肝可发生于任何年龄,其患病率和严重程度因种族和性别而异。在过去 10 年中,非酒精性脂肪肝在女性中的发病率呈上升趋势,与男性相比,其死亡率也急剧上升。无论性别如何,非酒精性脂肪肝的重要预后风险因素包括年龄、肥胖、2 型糖尿病、胰岛素抵抗和血脂异常。女性非酒精性脂肪肝的临床过程和预后取决于年龄、生育阶段和合成激素的使用情况。与绝经后的男性和女性相比,绝经前的女性肝纤维化程度较轻,预后较好。文章描述了非酒精性脂肪肝在生育期、绝经前和绝经后的病程特点,描述了肝脏脂肪变性对妊娠过程和结果、母亲和胎儿围产期状况的影响。因此,非酒精性脂肪肝的患病率、风险因素、纤维化和临床结果都存在性别差异。非酒精性脂肪肝在育龄期的发病率和严重程度以男性较高,但在绝经期后,这种病变在女性,尤其是患有代谢紊乱的女性中有所增加。肝脏脂肪变性会影响妊娠、分娩和产后的进程。
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Features of the course of non-alcoholic fatty liver disease in women at different age periods: literature review
The review examines the epidemiology and risk factors of non-alcoholic fatty liver disease (NAFLD) for women. According to various sources, the global prevalence of NAFLD ranges from 20 to 40% of the adult population in the world. In Russia, 37.3% of polyclinic patients have NAFLD. NAFLD can occur at any age and has differences in prevalence and severity depending on ethnicity and gender. Over the past 10 years, there has been a trend towards an increase in the prevalence of NAFLD among women, as well as a sharper increase in mortality compared to men. Regardless of gender, prognostically significant risk factors for NAFLD include age, obesity, type 2 diabetes mellitus, insulin resistance, dyslipidemia. The clinical course and prognosis of NAFLD in women depends on age, reproductive stage and use of synthetic hormones. Premenopausal women have less pronounced liver fibrosis and a better life prognosis compared to postmenopausal men and women. The article describes the features of the course of NAFLD in the reproductive period, pre- and postmenopausal period, characterizes the effect of liver steatosis on the course and outcome of pregnancy, the perinatal condition of the mother and fetus. Thus, there are gender differences in the prevalence, risk factors, fibrosis, and clinical outcomes of NAFLD. The prevalence and severity of NAFLD in reproductive age is higher in men, but after menopause, there is an increase in this pathology in women, especially those with metabolic disorders. Liver steatosis can affect the course of pregnancy, labor and postpartum periods.
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