Newson Louise, Manyonda Isaac, Lewis Rebecca, Preissner Robert, Preissner Saskia, Seeland Ute
Newson Health Ltd, Winton House, Stratford-upon-Avon, United Kingdom.
Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Front Glob Womens Health. 2021 May 11;2:651752. doi: 10.3389/fgwh.2021.651752. eCollection 2021.
The incidence of SARS-CoV2 infections is around 15% higher in premenopausal women compared to age matched men, yet the fatality rate from COVID-19 is significantly higher in men than women for all age strata. Sex differences have also been observed in recent epidemics including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), with SARS-CoV 2 virus infection sex differences appear more dramatic. The regulation and expression of the angiotensin converting enzyme 2 (ACE2) is the key for this special coronavirus SARS-CoV-2 to enter the cell. 17β-oestradiol increases expression level and activity of angiotensin converting enzyme-2 (ACE2) and the alternative signaling pathway of Ang II via the angiotensin II receptor type II (AT2R) and the Mas receptor is more dominant in female sex than in male sex. Maybe a hint to explain the higher infection risk in women. The same hormonal milieu plays a major role in protecting women where morbidity and mortality are concerned, since the dominant female hormone, oestradiol, has immune-modulatory properties that are likely to be protective against virus infections. It is also known that the X chromosome contains the largest number of immune-related genes, potentially conferring an advantage to women in efficient immune responsiveness. Lifestyle factors are also likely to be contributory. Premenopausal women could possibly face higher exposure to infection (hence higher infection rates) because economic conditions are often less favorable for them with less opportunity for home office work because of jobs requiring mandatory attendance. Due to the additional task of childcare, it is likely that contact times with other people will be longer. Women generally make healthier lifestyle choices, thus reducing the disease burden that confers high risk of mortality in COVID-19 infected men. This narrative review aims to present key concepts and knowledge gaps on the effects of oestrogen associated with SARS-CoV2 infection and COVID-19 disease.
与年龄匹配的男性相比，绝经前女性感染严重急性呼吸综合征冠状病毒2（SARS-CoV2）的发生率高出约15%，然而在所有年龄层中，男性因冠状病毒病（COVID-19）的死亡率显著高于女性。在包括严重急性呼吸综合征（SARS）和中东呼吸综合征（MERS）在内的近期疫情中也观察到了性别差异，而SARS-CoV-2病毒感染的性别差异似乎更为显著。血管紧张素转换酶2（ACE2）的调节和表达是这种特殊的冠状病毒SARS-CoV-2进入细胞的关键。17β-雌二醇可增加血管紧张素转换酶2（ACE2）的表达水平和活性，且通过血管紧张素II 2型受体（AT2R）和Mas受体的血管紧张素II替代信号通路在女性中比在男性中更占主导地位。这可能是解释女性感染风险较高的一个线索。在发病率和死亡率方面，相同的激素环境在保护女性方面起着重要作用，因为占主导地位的女性激素雌二醇具有免疫调节特性，可能对病毒感染具有保护作用。还已知X染色体包含数量最多的免疫相关基因，这可能使女性在有效的免疫反应方面具有优势。生活方式因素也可能起作用。绝经前女性可能面临更高的感染暴露风险（因此感染率更高），因为她们的经济状况往往较差，由于工作需要强制出勤，在家办公的机会较少。由于有照顾孩子的额外任务，她们与其他人的接触时间可能会更长。女性通常会做出更健康的生活方式选择，从而减轻了疾病负担，而这种负担会使感染COVID-19的男性面临高死亡风险。本叙述性综述旨在介绍与SARS-CoV2感染和COVID-19疾病相关的雌激素作用的关键概念和知识空白。
