He Weihang, Liu Xiaoqiang, Feng Liang, Xiong Situ, Li Yulei, Chen Luyao, Li Yu, Wang Gongxian, Li Dongshui, Fu Bin
Reproductive Medicine Center, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Front Med (Lausanne). 2020 Nov 19;7:594364. doi: 10.3389/fmed.2020.594364. eCollection 2020.
Coronavirus Disease 2019 (COVID-19) has created a global pandemic. Global epidemiological results show that elderly men are susceptible to infection of COVID-19. The difference in the number of cases reported by gender increases progressively in favor of male subjects up to the age group ≥60-69 (66.6%) and ≥70-79 (66.1%). Through literature search and analysis, we also found that men are more susceptible to SARS-CoV-2 infection than women. In addition, men with COVID-19 have a higher mortality rate than women. Male represents 73% of deaths in China, 59% in South Korea, and 61.8% in the United States. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen of COVID-19, which is transmitted through respiratory droplets, direct and indirect contact. Genomic analysis has shown that SARS-CoV-2 is 79% identical to SARS-CoV, and both use angiotensin-converting enzyme 2 (ACE2) as the receptor for invading cells. In addition, Transmembrane serine protease 2 (TMPRSS2) can enhance ACE2-mediated virus entry. However, SARS-CoV-2 has a high affinity with human ACE2, and its consequences are more serious than other coronaviruses. ACE2 acts as a "gate" for viruses to invade cells and is closely related to the clinical manifestations of COVID-19. Studies have found that ACE2 and TMPRSS2 are expressed in the testis and male reproductive tract and are regulated by testosterone. Mature spermatozoon even has all the machinery required to bind SARS-CoV-2, and these considerations raise the possibility that spermatozoa could act as potential vectors of this highly infectious disease. This review summarizes the gender differences in the pathogenesis and clinical manifestations of COVID-19 and proposes the possible mechanism of orchitis caused by SARS-CoV-2 and the potential transmission route of the virus. In the context of the pandemic, these data will improve the understanding of the poor clinical outcomes in male patients with COVID-19 and the design of new strategies to prevent and treat SARS-CoV-2 infection.
2019冠状病毒病（COVID-19）已引发全球大流行。全球流行病学结果显示，老年男性易感染COVID-19。按性别报告的病例数差异在年龄组≥60 - 69岁（66.6%）和≥70 - 79岁（66.1%）时逐渐增大，更有利于男性。通过文献检索和分析，我们还发现男性比女性更易感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。此外，感染COVID-19的男性死亡率高于女性。在中国，男性死亡病例占73%，在韩国占59%，在美国占61.8%。SARS-CoV-2是COVID-19的病原体，通过呼吸道飞沫、直接和间接接触传播。基因组分析表明，SARS-CoV-2与严重急性呼吸综合征冠状病毒（SARS-CoV）有79%的同源性，二者均以血管紧张素转换酶2（ACE2）作为入侵细胞的受体。此外，跨膜丝氨酸蛋白酶2（TMPRSS2）可增强ACE2介导的病毒进入。然而，SARS-CoV-2与人类ACE2具有高亲和力，其后果比其他冠状病毒更严重。ACE2作为病毒入侵细胞的“门户”，与COVID-19的临床表现密切相关。研究发现，ACE2和TMPRSS2在睾丸和男性生殖道中表达，并受睾酮调节。成熟精子甚至具备结合SARS-CoV-2所需的所有机制，这些因素增加了精子可能成为这种高传染性疾病潜在传播载体的可能性。本综述总结了COVID-19发病机制和临床表现中的性别差异，提出了SARS-CoV-2引起睾丸炎的可能机制及病毒的潜在传播途径。在大流行背景下，这些数据将有助于加深对COVID-19男性患者不良临床结局的理解，并为预防和治疗SARS-CoV-2感染新策略的设计提供帮助。
Zotero 插件