女性绝经与非酒精性脂肪性肝病的关系及相关治疗的研究进展

doi:10.3969/j.issn.1674-8115.2023.01.017

摘要/Abstract

摘要：

非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）是慢性非传染性疾病，是代谢综合征（metabolic syndrome，MS）在肝脏的表现。绝经是女性因卵巢功能衰退所呈现的生理现象，表现为下丘脑-垂体功能退化。临床和流行病学研究表明，NAFLD的发病趋势具有两性差异，且与血糖、血脂、血尿酸等代谢参数有关。女性绝经前NAFLD发病率低于男性，而绝经后NAFLD的发病率逐渐升高至与男性相当，其机制可能主要与女性绝经后体内性激素的变化（以雌激素的下降为主）有关。性激素的变化，如雌激素和性激素结合球蛋白（sex hormone binding globulin，SHBG）水平降低而雄激素水平相对升高，会增加腹型肥胖、血脂代谢异常及胰岛素抵抗（insulin resistance，IR）等异常指标的发生率，使绝经成为女性NAFLD的重要的独立危险因素；而雄激素受体拮抗剂、雌激素及植物雌激素等可通过多种途径改善肝脏脂肪变性及IR，减轻NAFLD的严重程度，延缓肝纤维化进展，对绝经女性NAFLD有一定治疗意义，但也具有部分局限性。该文就近年来女性绝经与NAFLD相关关系的研究进展予以综述，为绝经女性NAFLD的预防和治疗提供思路和参考。

关键词: 非酒精性脂肪性肝病, 绝经, 胰岛素抵抗, 代谢综合征, 植物雌激素

Abstract:

Non-alcoholic fatty liver disease (NAFLD) is a chronic non-communicable disease. It is a metabolic syndrome (MS) in the liver. Menopause is a physiological phenomenon of women due to the decline of ovarian function, which is characterized by the deterioration of hypothalamic-pituitary function. Clinical and epidemiological studies have shown that the incidence trend of NAFLD has gender differences and is related to metabolic parameters such as glucose, lipids, and blood uric acid. The incidence of NAFLD in premenopausal women is lower than that in males, while the incidence of NAFLD in postmenopausal women gradually increases to the same as that in males. The mechanism may be mainly related to the changes of sex hormones in postmenopausal women (mainly the decrease of estrogen). The changes of sex hormones such as the decreased levels of estrogen and sex hormone binding globulin (SHBG) and the relatively increased level of androgen can increase the incidence of MS components such as abdominal obesity, abnormal blood lipid metabolism and insulin resistance (IR), making menopause an important independent risk factor for NAFLD in women. Estrogen, androgen receptor antagonists and phytoestrogens can improve hepatic steatosis and IR through many ways, reduce the severity of NAFLD and delay its progression to liver fibrosis, which have certain therapeutic significance for postmenopausal women with NAFLD, but also have some limitations. This paper reviews the research progress in the relationship between menopause and NAFLD in recent years, so as to provide ideas and reference for the prevention and treatment of NAFLD in postmenopausal women.

Key words: nonalcoholic fatty liver disease (NAFLD), menopause, insulin resistance (IR), metabolic syndrome (MS), phytoestrogen

中图分类号:

R575.5

刘薇薇, 王龙. 女性绝经与非酒精性脂肪性肝病的关系及相关治疗的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(1): 125-131.

LIU Weiwei, WANG Long. Research progress in the correlation and treatment of menopause and non-alcoholic fatty liver disease in women[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 125-131.

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