The COVID-19 outbreak is a global public health issue, having profound effects on most aspects of societal well-being, including physical and mental health. A plethora of studies, globally, have suggested the existence of a sex disparity in the outcome of COVID-19 patients, that is mainly due to mechanisms of viral infection, immune response to the virus, development of a hyperinflammation, and development of systemic complications, particularly thromboembolism. These differences appear to be more pronounced in elderly COVID-19 patients. Epidemiological data report a sex difference in the severity and outcome of COVID-19 disease with a more favourable course of the disease in women compared to men, regardless of age range although the rate of SARS-CoV-2 infection seems to be similar in both sexes. Sex hormones, including androgens and estrogens, may not only impact viral entry and load, but also shape the clinical manifestations, complications and, ultimately, the outcome of COVID-19 disease. The current review comprehensively summarizes current literature on sex disparities in susceptibility and outcomes of COVID-19 disease as well as the literature underpinning the pathophysiological and molecular mechanisms, which may provide a rationale to a sex disparity. These include sex hormone influences on molecules that facilitate virus entry and priming, as well as the immune and inflammatory response, as well as coagulation and thrombosis diathesis. Based on present evidence, women appear to be relatively protected from COVID-19 because of a more effective immune response and a less pronounced systemic inflammation, with consequent moderate clinical manifestations of the disease, together with a lesser predisposition to thromboembolism. Conversely, men appear to be particularly susceptible to COVID-19 disease because of a less effective immune response with consequent increased susceptibility to infections, together with a greater predisposition to thromboembolism. In elderlies, sex disparities in overall mortality following SARS-CoV-2 infection is even more palpable, as elderly men appear more prone to severe COVID-19 because of a greater predisposition to infections, a weaker immune defence and an enhanced thrombotic state compared to women. The review highlights potential novel therapeutic approaches employing the administration of hormonal or anti-hormonal therapy in combination with antiviral drugs in COVID-19 patients.


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COVID-19 严重程度和结果的性别差异：男性较弱还是女性较强？

COVID-19 疫情是一个全球公共卫生问题，对社会福祉的大多数方面（包括身心健康）产生深远影响。全球范围内的大量研究表明，COVID-19 患者的结局存在性别差异，这主要是由于病毒感染机制、对病毒的免疫反应、过度炎症的发展以及全身并发症的发展造成的。 ，特别是血栓栓塞。这些差异在老年 COVID-19 患者中似乎更为明显。流行病学数据显示，无论年龄范围如何，COVID-19 疾病的严重程度和结果均存在性别差异，尽管 SARS-CoV-2 感染率在男女中似乎相似，但与男性相比，女性的病程更有利。性别。性激素，包括雄激素和雌激素，不仅可能影响病毒进入和载量，还会影响 COVID-19 疾病的临床表现、并发症以及最终的结果。本综述全面总结了有关 COVID-19 疾病易感性和结果方面性别差异的现有文献，以及支持病理生理学和分子机制的文献，这可能为性别差异提供了理论依据。这些包括性激素对促进病毒进入和启动的分子的影响，以及免疫和炎症反应，以及凝血和血栓形成素质。根据目前的证据，女性似乎相对免受 COVID-19 感染，因为她们有更有效的免疫反应和不太明显的全身炎症，随之而来的是中等程度的疾病临床表现，以及较少的血栓栓塞倾向。相反，男性似乎特别容易感染 COVID-19 疾病，因为其免疫反应效果较差，因此更容易受到感染，并且更容易发生血栓栓塞。在老年人中，SARS-CoV-2 感染后总体死亡率的性别差异更加明显，因为与男性相比，老年男性更容易感染、免疫防御较弱且血栓状态增强，因此似乎更容易患上严重的 COVID-19女性。该综述强调了对 COVID-19 患者采用激素或抗激素疗法联合抗病毒药物的潜在新颖治疗方法。