New Lancet article reveals why men are more susceptible to new crown virus

Beijing News (Reporter Xu Wen Xie Lian) A retrospective research article published on January 29 in the International Medical Journal Lancet showed that 99 new coronaviruses treated at Wuhan Jinyintan Hospital from January 1 to 20 More men than women are infected, the same as SARS and MERS viruses. The article suggests that women’s slightly lower virus susceptibility may be due to the protection of X chromosomes and gonadal hormones, both of which play important roles in innate and adaptive immunity.

The paper is entitled “Epidemiology and clinical manifestations of 99 cases of new coronavirus pneumonia in Wuhan, China 2019: a descriptive study”. Corresponding authors are Professor Zhang Li of Wuhan Jinyintan Hospital and Professor Zhang Xinxin of Shanghai Ruijin Hospital.

The study also found that the new coronavirus may mainly affect lymphocytes, especially T lymphocytes. This is the same as SARS virus. It is recommended to use intravenous immunoglobulin to enhance the anti-infective ability of critically ill patients.

49 of the 99 patients had a history of exposure to the South China Seafood Market

The study included all confirmed cases of Wuhan Jinyintan Hospital from January 1 to January 20, 2020. These cases were diagnosed by RT-PCR (real-time quantitative reverse transcription polymerase chain reaction), and their characteristics and laboratory data were analyzed from the perspectives of epidemiology, demography, clinical medicine, radiology, and so on. Results Follow-up to January 25.

The study showed that of the 99 patients, 49 had a history of contact with the South China Seafood Market, of which 47 had long-term contact and 2 had short-term contact; the average age of the patients was 55.5 years, including 67 men and 32 women; by RT-PCR The test, 2019-nCoV (new coronavirus) was detected in all patients; 50 patients had chronic disease.

The clinical manifestations of the patients were: fever (82 patients), cough (81 patients), shortness of breath (31 patients), muscle pain (11 patients), confusion (9 patients), headache (8 patients) , Sore throat (5 patients), runny nose (4 patients), chest pain (2 patients), diarrhea (2 patients), nausea and vomiting (1 patient).

Imaging studies showed that 74 patients showed bilateral pneumonia, 14 patients showed multiple mottled and ground-glass opacities, and 1 patient had pneumothorax. Seventeen patients developed acute respiratory distress syndrome, of which 11 patients worsened within a short period of time and died of multiple organ failure.

The study reminds that early detection and timely treatment are very important for 2019-nCoV infection cases. Effective life support and active treatment of complications should be provided to effectively reduce the severity of the patient’s condition while preventing the virus from spreading in China and worldwide.

New coronavirus infection more likely to affect older men with comorbidities

Studies have pointed out that the cluster of 2019-nCoV infections is more likely to affect older men with comorbidities and may cause severe or even fatal respiratory diseases, such as acute respiratory distress syndrome.

Overall, the characteristics of the dead patients are consistent with the MuLBSTA score, an early warning model for predicting mortality from viral pneumonia. The MuLBSTA scoring system includes six indicators, namely, multi-leaf infiltration, lymphopenia, bacterial co-infection, smoking history, hypertension, and age.

Researchers have observed that in the 99 cases of 2019-nCoV infection, more men than women. This is the same as SARS virus and MERS virus. Researchers believe that women’s slightly lower virus susceptibility may be due to the protection of X chromosomes and gonadal hormones, both of which play important roles in innate and adaptive immunity.

Some patients, especially those who are seriously ill, are infected with bacteria and fungi. Common bacterial cultures in patients with secondary infections include Acinetobacter baumannii, Klebsiella pneumoniae, Aspergillus flavus, Chlorococcus albicans and Candida albicans. The high resistance rate of A. baumannii may make anti-infective treatment difficult, which leads to a higher possibility of septic shock.

For severe mixed infections, in addition to the pathogenic factors of the pathogen, the immune status of the patient is also one of the important factors. Older age, obesity, and comorbidities may be associated with increased mortality. When people with low immune function, such as the elderly, diabetic patients, HIV-infected people, people who have been using immunosuppressants for a long time, and pregnant women are infected with 2019nCoV, timely use of antibiotics to prevent infection and strengthen immune support treatment may reduce complications and mortality .

New coronavirus may act primarily on lymphocytes

Laboratory tests have shown that the absolute value of lymphocytes has decreased in most patients. This indicates that 2019-nCoV, like SARS virus, may mainly affect lymphocytes, especially T lymphocytes.

Some studies have shown that a drastic reduction in the total number of lymphocytes indicates that the coronavirus has depleted many immune cells and suppressed the body’s cellular immune function. The damage of T lymphocytes may be an important factor leading to the deterioration of patients’ condition. The low absolute value of lymphocytes can be used as a reference indicator in the clinical diagnosis of new coronavirus infections.

The virus particles spread through the respiratory mucosa and infect other cells, induce a cytokine storm in the body, generate a series of immune responses, and cause changes in peripheral leukocytes and immune cells (such as lymphocytes). Some patients rapidly develop acute respiratory distress syndrome and septic shock, eventually leading to multiple organ failure.

Therefore, early detection and timely treatment of critical cases is essential. Intravenous immunoglobulin is recommended to enhance the anti-infective capacity of critically ill patients, and steroids are used in patients with acute respiratory distress syndrome (methylprednisolone 1–2 mg / kg daily), and the duration of treatment should be as short as possible.

However, the author also pointed out that the study has certain limitations, including the small number of cases and the exclusion of suspected and undiagnosed cases, and the inability to obtain more detailed patient clinical information.

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