Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
Biol Sex Differ. 2020 May 25;11(1):29. doi: 10.1186/s13293-020-00304-9.
Emerging evidence from China suggests that coronavirus disease 2019 (COVID-19) is deadlier for infected men than women with a 2.8% fatality rate being reported in Chinese men versus 1.7% in women. Further, sex-disaggregated data for COVID-19 in several European countries show a similar number of cases between the sexes, but more severe outcomes in aged men. Case fatality is highest in men with pre-existing cardiovascular conditions. The mechanisms accounting for the reduced case fatality rate in women are currently unclear but may offer potential to develop novel risk stratification tools and therapeutic options for women and men.
The present review summarizes latest clinical and epidemiological evidence for gender and sex differences in COVID-19 from Europe and China. We discuss potential sex-specific mechanisms modulating the course of disease, such as hormone-regulated expression of genes encoding for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) entry receptors angiotensin converting enzyme (ACE) 2 receptor and TMPRSS2 as well as sex hormone-driven innate and adaptive immune responses and immunoaging. Finally, we elucidate the impact of gender-specific lifestyle, health behavior, psychological stress, and socioeconomic conditions on COVID-19 and discuss sex specific aspects of antiviral therapies.
The sex and gender disparities observed in COVID-19 vulnerability emphasize the need to better understand the impact of sex and gender on incidence and case fatality of the disease and to tailor treatment according to sex and gender. The ongoing and planned prophylactic and therapeutic treatment studies must include prospective sex- and gender-sensitive analyses.
中国的新证据表明，2019 年冠状病毒病（COVID-19）对男性感染者的致死率高于女性，中国男性的病死率为 2.8%，而女性为 1.7%。此外，几个欧洲国家 COVID-19 的性别分类数据显示，两性之间的病例数相似，但老年男性的预后更差。有心血管疾病既往史的男性病死率最高。目前尚不清楚导致女性病死率降低的机制，但可能为女性和男性开发新的风险分层工具和治疗方案提供潜在机会。
本综述总结了来自欧洲和中国的关于 COVID-19 中性别和性差异的最新临床和流行病学证据。我们讨论了潜在的调节疾病进程的特定于性别的机制，例如激素调节编码严重急性呼吸综合征冠状病毒 2（SARS-CoV2）进入受体血管紧张素转换酶（ACE）2 受体和 TMPRSS2 的基因表达，以及性激素驱动的先天和适应性免疫反应和免疫衰老。最后，我们阐明了特定于性别的生活方式、健康行为、心理压力和社会经济状况对 COVID-19 的影响，并讨论了抗病毒治疗的性别特异性方面。
COVID-19 易感性中观察到的性别差异强调需要更好地了解性别对疾病发病率和病死率的影响，并根据性别调整治疗方法。正在进行和计划中的预防性和治疗性治疗研究必须包括前瞻性的性别敏感分析。
