Sex-based clinical and immunological differences in COVID-19.
Sex-based clinical and immunological differences in COVID-19.
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COVID-19 中基于性别的临床和免疫学差异
DOI：
10.1186/s12879-021-06313-2
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发表时间：
2021-07-05
影响因子：
3.7
通讯作者：
Wang Q
中科院分区：
文献类型：
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作者：
Huang B;Cai Y;Li N;Li K;Wang Z;Li L;Wu L;Zhu M;Li J;Wang Z;Wu M;Li W;Wu W;Zhang L;Xia X;Wang S;Chen H;Wang Q
男性和女性对外来病原体的免疫反应不同。然而，目前大多数COVID-19临床实践和试验并未考虑性别因素。方法对来自同一中心的1558例男性和1499例女性COVID-19患者的临床结局、外周免疫细胞和SARS-CoV-2特异性抗体水平进行性别比较分析。流式细胞术检测淋巴细胞亚群。化学发光法测定总抗体、刺突蛋白(S)-、受体结合域(RBD)-和核蛋白(N)-特异性IgM和IgG水平。结果男性患者的ICU入院率（男性和女性分别为4.7%和2.7%，P= 0.005）和死亡率（男性和女性分别为3%和1.4%，P= 0.004）约为女性患者的两倍。生存分析显示，男性是COVID-19死亡的独立危险因素（校正风险比[HR] = 2.22, 95%可信区间[CI]: 1.3 ~ 3.6，P= 0.003）。男性住院期间外周血炎症因子水平较高。肾脏异常（男女分别为102/1588[6.5%]比63/1499 [4.2%]，P= 0.002）和肝脏异常（650/1588[40.9%]比475/1499 [31.7%]，P= 0.003）在男性患者中较女性患者多见。通过分析症状出现后淋巴细胞亚群的动态变化，我们发现女性患者在COVID-19病程中CD19+ B细胞和CD4+ T细胞的百分比普遍较高。值得注意的是，女性患者对SARS-CoV-2的保护性rbd特异性IgG在出现症状后第4周急剧升高并达到峰值，而男性患者在出现症状后第7周逐渐升高并达到峰值。结论男性在SARS-CoV-2感染和恢复期间预后不良，炎症反应高，淋巴细胞百分比低，抗体反应迟钝。早期医疗干预和密切监测非常重要，特别是对男性COVID-19患者。
BackgroundMales and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration.MethodsWe performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence.ResultsWe found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively,P= 0.005) and mortality (3% vs. 1.4%, in males and females, respectively,P= 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio [HR] = 2.22, 95% confidence interval [CI]: 1.3–3.6,P= 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively,P= 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%],P= 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients.ConclusionsMales had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients.
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DOI：
10.4049/jimmunol.1601896
发表时间：
2017-05-15
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Channappanavar R;Fett C;Mack M;Ten Eyck PP;Meyerholz DK;Perlman S
通讯作者：
Perlman S
影响因子：
28.2
作者：
Liu, Yuwei;Du, Xuebei;Zhao, Yan
通讯作者：
Zhao, Yan
影响因子：
11.8
作者：
Qin, Chuan;Zhou, Luoqi;Tian, Dai-Shi
通讯作者：
Tian, Dai-Shi
影响因子：
32.4
作者：
Ni, Ling;Ye, Fang;Dong, Chen
通讯作者：
Dong, Chen
影响因子：
6.7
作者：
Meng, Yifan;Wu, Ping;Wu, Peng
通讯作者：
Wu, Peng