评论文章：肝硬化的妇女管理

StephenW

Review article: the management of cirrhosis in women

    A. M. Allen and
    J. E. Hay*

Article first published online: 28 SEP 2014

DOI: 10.1111/apt.12974


Alimentary Pharmacology & Therapeutics

Volume 40, Issue 10, pages 1146–1154, November 2014

Summary
Background

There are differences in the predisposition, natural history of liver disease, complications and treatment response between men and women.
Aim

To review clinical differences in cirrhosis between men and women and to address unique management issues of fertility, pregnancy and contraception in this patient population.
Methods

PubMed and MEDLINE were searched using the terms ‘cirrhosis’ and ‘chronic liver disease’, each cross-referenced with specific liver diseases, as well as terms such as ‘cancer’, ‘hepatocellular carcinoma’, ‘smoking’, ‘liver transplantation’, ‘metabolic bone disease’, ‘fertility’,’ pregnancy’ and ‘contraception’.
Results

Pre-menopausal status is protective in viral hepatitis C and non-alcoholic steatohepatitis. However, smoking, especially in combination with alcohol, is a stronger risk factor for cirrhosis and malignancies in women with chronic liver disease compared to men, although they are less likely than men to develop hepatocellular carcinoma. Women with cirrhosis have more osteopenic bone disease than men and require active management. Successful pregnancy is possible in well-compensated cirrhosis or with mild portal hypertension, although the maternal and foetal mortality and morbidity are higher than in the general population. The maternal risk correlates with liver disease severity and derives mostly from variceal bleeding. The choices for contraception in compensated cirrhosis are generally the same as for the general population. Women with cirrhosis are disadvantaged by the current MELD system of organ allocation, at least in part due to body size.
Conclusion

The management of women with chronic liver disease is unique in regards to counselling, screening for complications, fertility and pregnancy.

StephenW

评论文章：肝硬化的妇女管理

    答：M.艾伦和
    J.E。干草*

文章首次发表时间：2014年9月28日

DOI：10.1111/ apt.12974


消化系统药理学与治疗学

40卷，第10期，页1146至1154年，2014年11月

摘要
背景

还有的易感性差异，肝脏疾病，并发症和男女之间的治疗反应的自然史。
目的

审查在男性和女性之间的性肝硬化的临床差异并解决这些患者的生育能力，怀孕和避孕的独特的管理问题。
方法

PubMed和MEDLINE用的术语“硬化”和“慢性肝病”，检索各个交叉引用的特定肝脏疾病，以及术语如“癌症”，“肝癌”，“吸烟”，“肝移植”，“代谢性骨病”，“生育”，“怀孕”和“避孕”。
结果

绝经期前的状态为保护在病毒性丙型肝炎和非酒精性脂肪性肝炎。然而，吸烟，尤其是在与酒精结合，是肝硬化和恶性肿瘤的妇女都患有慢性肝病的男性相比更强的风险因素，尽管他们不太可能比男性发展肝癌。妇女与肝硬化有更多的骨量不足的疾病比男性需要积极的管理。成功怀孕有可能在良好的代偿性肝硬化或轻度门脉高压，虽然产妇和胎儿的死亡率和发病率比一般人群高。产妇的风险相关性肝病的严重程度和静脉曲张破裂出血源于居多。在肝硬化代偿期避孕的选择一般都是一样的普通人群。女性肝硬化是由器官分配的电流MELD系统处于不利地位，至少部分原因是由于车身尺寸。
结论

女性患有慢性肝病的管理是关于辅导独特，筛查并发症，生育和怀孕。