Together ︱健康的性别差异：从新冠病毒感染大流行中得到的经验
2023/1/27 13:38:26 性健康研究与教育

     哈医大性健康研究与教育 Together?一个可思、有悟，且有为的交流与分享平台美好与同行一直在这里

    

    重要事实(世界卫生组织)

     性别是指社会构建的角色，它所塑造的是在特定社会文化背景下被认为适合

     所有人的行为、活动、期望和机会。性别也指人与人之间的关系，以及这些

     关系中的权力分配。

     性别与生物自然性别(男性和女性)相互作用，但却与之不同。

     性别是健康不公平的一个决定因素，既单独存在，又与社会经济地位、年龄

     、种族、残疾状况、性取向等相互交叉。

     性别通过与其他决定因素的相互作用，以及对风险和暴露、行为以及卫生系

     统反应的性别特征的影响，与可持续发展目标3的所有具体目标发生关联。

     性别对卫生保健和社会护理工作者的就业、工作条件和职业轨迹带来影响。

     世卫组织正在努力支持会员国促进建立对性别敏感的卫生系统。这种系统承

     认和理解性别如何影响到健康行为、服务获取、医疗路径以及性别如何与其

     他健康决定因素和不公平因素相互作用，并使之作出改变。

     Sex andGender Differences in Health: What the COVID-19 Pandemic Can Teach Us

     健康的性别差异：从新冠病毒感染大流行中得到的经验

     文本来源｜

     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249504/

     文本翻译｜张晗，硕士研究生(2022级)，RECSG

     Sex, biologicaland physiologic traits characterizing males and females; and gender, acontinuum of socio-culturally constructed roles and behaviors associated withmen, women, and gender-spectrum diversity, are among the most importantdeterminants of health and disease outcomes. However, these fundamental factorsare often ignored in biomedical research and are rarely incorporated intoclinical care. We call for sex- and gender-specific and differentiating factorsto be urgently included in the research, prevention, and therapeuticsimplementation response to the coronavirus disease 2019 (COVID-19) pandemic.生理性别，是基于生物属性和生理特征而划分的男女两性之区别；社会性别，是通过社会文化建构的角色和行为的连续统一体，是与男人、女人和性别多样性相关的内容，也是影响健康和疾病产生的重要决定因素之一。然而，这些基础因素在生物医学研究中经常被忽视，很少被纳入临床照护中。因此我们呼吁在新冠病毒大流行的研究、预防和治疗过程中将性别特点与差异性作为重要的考虑因素。Although availablesex-disaggregated data for COVID-19 show equal numbers of cases between sexes,current evidence indicates that fatality rates are higher in men than in women.A recent report (23 April 2020) from the Italian National Institute of Healthshows that of 23188 deaths from COVID-19 infection in Italy, approximately 70%were in men. In the United States, provisional death counts for COVID-19 fromFebruary to April 2020 similarly indicate a sex bias in fatality rates: Of 37308 deaths reported by the National Center for Health Statistics, 59% were inmen. Similar trends have been reported in China[1] and South Korea[2].虽然按性别区隔进行统计的数据显示，现有的与新冠病毒疫情有关的男女病例数是相等的，但目前的证据表明，男性病死率高于女性。意大利国家卫生研究院于2020年4月23日的报告显示，在意大利因新冠病毒疫情死亡人数为23188例，其中约70%为男性。美国2020年2月至4月新冠病毒疫情的死亡人数同样表明了死亡率的性别差异，即在国家卫生统计中心报告的37308例死亡病例中，59%为男性。类似状况在中国[1]和韩国[2]也有报道。Takentogether, these preliminary data suggest that sex- and gender-related factorsmay be implicated in COVID-19 vulnerability. As scientists, we may considerthis an interesting observation to be explored in post hoc analyses, usingavailable sex and gender data. Or we can investigate a priori the specific roleof these factors and potentially leverage the mechanisms implicated in sex andgender differences in COVID-19 risk, progression, and outcomes, to identifyeffective prevention and treatment interventions for the entire population.Adopting a sex- and gender-informed perspective in research has already shownto improve patient care for cardiovascular diseases and other conditions thataffect both women and men[3].总体而言，这些初期数据表明，性别相关因素可能与新冠病毒的易感性有关联。作为科学研究人员，我们认为这是一个值得关注的现象，可利用现有的性别数据通过额外分析进一步探索。或者，我们也可以先进行调查，分析这些因素的具体作用，以及在新冠病毒引发的疾病中性别因素在病毒感染风险、疾病进展和演变结果中的差异性，针对整个人群制定有效的预防和治疗干预措施。已经有研究表明，基于性别视角的医疗救治和照护，可以改善那些患有心血管疾病和其他疾病患者的状况[3]。Translatingthis perspective to the study of COVID-19 infection requires the first andessential step of collecting large-scale sex- and gender-disaggregated data.This task may pose some methodological challenges for gender, given the lack ofvalidated tools to assess gender. Using sex when reporting biological factorsand gender when reporting gender identity or sociocultural factors, and askingindividuals about both their sex assigned at birth and their current genderidentity, may facilitate data collection and improve comparability acrossstudies.将这一观点引入到新冠病毒感染的相关研究中，首要的是收集大规模的按性别分类的数据。鉴于缺乏有效评估社会性别的工具，这项任务可能对性别问题提出一些方法上的挑战。当我们使用生理性别报告生理因素，而谈到社会性别时会使用性别认同或社会文化因素，以及询问个人出生时的性别和当前的性别认同，这可能有助于数据收集和提高不同研究间的可比性。However,truly sex- and gender-informed research exceeds mere stratification by thesevariables. Researchers should also systematically assess biological(such ashormonal state, immune function, comorbid conditions, and concurrenttreatments) and gender related (such as lifestyle and socioeconomic status)factors in patients with COVID-19. Furthermore, as clinical trialsinvestigating novel therapeutics to prevent and treat COVID-19 infection arebeing launched worldwide, it is imperative to incorporate sex- and gender relateddata into these trials and to analyze and report treatment outcomesdisaggregated by sex and gender.然而，真正检视性别影响的研究不仅仅是对这些变量进行分层。研究者还应系统评估新冠病毒感染者的生物学方面的状况(比如，激素水平、免疫功能、合并症和并发治疗)和社会性别方面的信息(比如，生活方式和社会经济地位)。此外，随着针对新冠病毒感染的预防和新型疗法的临床实验在全球范围内的启动，必须将与性别的相关数据纳入其中，并按照性别分类对治疗结果进行分析报告。Takingthese actions will be crucial to address several fundamental questions relatedto COVID-19. For example, we may elucidate to what extent sex biases inCOVID-19 outcomes are linked to differences in sex hormone profiles. Sexhormones contribute to different immunologic responses in men and women: As ageneral rule, estrogens promote both innate and adaptive immune responses,which result in faster clearance of pathogens and greater vaccine efficacy.Conversely, testosterone has largely suppressive effects on immune function,which may explain the greater susceptibility to infectious diseases observed inmen[3]. Notably, changes in sex hormone may further shape the immune responseto pathogens, highlighting the importance of studying factors that affect suchlevels (for example, age, pregnancy, menstrual cycle, exogenous sex-hormonetherapies, men, and transgender individuals).采取这些研究行动，对于解决与新冠病毒感染有关的一些基本问题是至关重要的。例如，我们可以阐明新冠病毒感染结果中出现的性别差异性在何种程度上与性激素分布的差异性有关。性激素在男性和女性中会带来不同的免疫反应。一般而言，雌激素可促发先天性和后天性的免疫反应，从而更快地清除病原体，提高疫苗效力。相反，睾酮(最主要的雄激素)对免疫功能有很大的抑制作用，这可能是男性易感传染病的原因[3]。值得注意的是，性激素的变化可能进一步改变机体对病原体的免疫反应，这无疑显示出对相关的影响因素进行研究的重要性 (例如，年龄、怀孕、月经周期、外源性性激素疗法、男性和跨性别者)。Sex-relatedbiological data may also be critical to investigate the contribution of sexhormones to sex differences in inflammatory response. In particular, reductionin testosterone levels in aging men has been associated with increasedproinflammatory cytokine levels[4], which may contribute to worse COVID-19progression in older men. Sex differences in disease progression may also belinked to estrogen-induced decreased expression of angiotensin-convertingenzyme 2[5], which acts as a functional receptor for SARS-CoV-2 (the viruscausing COVID-19) to enter host target cells.与生理性别相关的生物学方面的数据可能有助于解释性激素在炎性反应方面出现的性别差异。尤其是，随着男性年龄增长而出现的睾酮水平降低与促炎细胞因子水平升高有关[4]，进而导致老年男性新冠病毒感染后的恶化。此外，疾病进展中的性别差异也可能与雌激素诱导的血管紧张素转换酶2(ACE2)的表达降低有关[5]，ACE2是严重急性呼吸道综合征冠状病毒2 (导致2019冠状病毒病)进入宿主靶细胞的功能受体。Investigatingsex hormone–influenced mechanisms and, more broadly, conducting sex- and genderinformed research may optimize the development of novel therapeutics and shedlight on drug efficacy, safety profiles, and adherence to treatments currentlytested for COVID-19, given that sex differences in pharmacokinetics andpharmacodynamics influence therapeutic effects and risk profiles of numerousmedications, and that gender-related factors affect adherence to treatment,access to health care, and health-seeking behaviors[3].研究性激素的影响机制，并广泛开展与性别相关的研究，有助于新冠病毒感染的新疗法研发，进一步探究治疗药物的疗效、安全性和依从性。这是因为药代动力学和药效学方面出现的性别差异会影响到许多药物的疗效和风险预测，而性别相关因素对于患者治疗的依从性、医疗健康服务的可及性和就医行为同样具有影响作用[3]。Stress-relateddisorders and the long-term consequences of COVID-19 on health outcomeshighlight another important effect of sex and gender. Beyond being a pandemicinfectious disease, COVID-19 also acts as a potent stressor, with millions ofindividuals experiencing fear and social isolation over a prolonged period.Exposure to persistent stress is associated with increased vulnerability to andseverity of stress-related psychiatric disorders (such as posttraumatic stressdisorder, panic disorder, and major depression), which occur more frequently inwomen than men[6]. Indeed, preliminary evidence from China during the initialphase of the COVID-19 outbreak shows an increased prevalence and severity ofdepressive, anxious, and posttraumatic symptoms in women than in men[7].因压力出现的障碍以及新冠病毒引发的疾病对于健康的长期后果，进一步表明了性别的重要影响。新冠病毒引发的感染不仅是一种大流行性传染病，还是一种强大的压力源，数百万人在长时间内经历恐惧和社会隔离。暴露在持续的压力之下，增加了精神疾病患者(如创伤后应激障碍、惊恐障碍和重度抑郁症)的脆弱性和患病的严重程度，而女性在这些疾病方面的发生率高于男性[6]。事实上，来自中国的初步证据表明，在新冠病毒疫情爆发的初始阶段，女性抑郁、焦虑和创伤后精神症状的患病率和严重程度高于男性[7]。Thisgender bias is supported by evidence of sex differences in stress responsesystems, which increase endocrine, affective, and arousal responses to stressin females[6,8], who also appear to be more susceptible to social isolation[9].Gender-related factors, such as the predominant roles of women as familycaregivers and as frontline health care workers, further exacerbate stressexposure. We have the unprecedented opportunity to conduct large longitudinalstudies to directly test whether the relationship between stress exposures andthe prevalence and presentation of stress-related psychiatric disorders ismediated by sex- and gender- related factors.上述的男女在疾病方面出现的不同状况是源于两性在应激反应系统中出现的差异，面对压力，女性的内分泌、情感和唤醒反应都出现增强的特点[6,8]，她们也似乎更容易受到社交孤立[9]。例如，女性主要作为家庭照顾者和一线医护人员的性别角色，进一步强化了她们的压力暴露状态。我们有前所未有的机会来进行大规模的纵向研究，以检视压力暴露和患病率之间的关系，以及性别相关因素对于应激相关的精神障碍的出现是否具有中介作用。On thebasis of these observations, we call on scientists and biomedical institutionsto recognize the importance of investigating sex- and gender-specific anddifferentiating effects of COVID-19 to develop and implement prevention andtreatment interventions able to address the acute and long-term effects of thispandemic on the health and well-being of the population. By doing so, we willreshape the way we think about diseases as we conceive and conduct research,thus optimizing health for the entire population.基于这些观察结果，我们呼吁科学家和生物医学研究机构能够认识到性别因素在新冠病毒感染疾病中的重要影响力及其差异性，以便制定和实施防治干预措施，应对这一流行病对人口健康及福祉的急性和长期影响。如此，有助于我们将在构建和开展研究时，重塑对疾病的思考方式，从而促进和提升全体民众的健康。参考文献(略)

    

    

    

    

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