Ruebner Rebecca L, Ng Derek, Mitsnefes Mark, Foster Bethany J, Meyers Kevin, Warady Bradley, Furth Susan L
Division of Nephrology, Department of Pediatrics, and.
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Clin J Am Soc Nephrol. 2016 Nov 7;11(11):1962-1968. doi: 10.2215/CJN.01270216. Epub 2016 Sep 14.
Prior studies suggested that women with CKD have higher risk for cardiovascular disease (CVD) and mortality than men, although putative mechanisms for this higher risk have not been identified. We assessed sex differences in (1) CVD risk factors and left ventricular hypertrophy (LVH), and (2) the relationship of left ventricular mass (LVM) with different measures of body size in children with CKD.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The study population comprised 681 children with CKD from the Chronic Kidney Disease in Children cohort, contributing 1330 visits. CVD risk factors were compared cross-sectionally by sex. LVH was defined as LVM/height >95th percentile and LVM relative to estimated lean body mass (eLBM) >95th percentile for age and sex. Differences in LVM by sex were assessed by adjusting for age, weight, height, and eLBM using bivariate and multivariate regression models.
Girls were less likely to have uncontrolled hypertension (26% versus 38%, P=0.001), had lower diastolic BP z-scores (+0.3 versus +0.6, P=0.001), and had lower prevalence of high triglycerides (38% versus 47%, P=0.03) compared with boys. When LVH was defined by LVM indexed to height, girls had higher prevalence of LVH (16% versus 9%, P=0.01); when LVH was defined by LVM relative to eLBM, prevalence of LVH was similar between girls and boys (18% versus 17%, P=0.92). In regression models adjusting for eLBM, no sex differences in LVM were observed.
Despite lack of increased prevalence of CVD risk factors, indexing LVM to height showed a higher proportion of LVH among girls, while estimates of LVH based on eLBM showed no sex differences. Indexing LVM to eLBM may be an alternative to height indexing in children with CKD.
既往研究表明，慢性肾脏病（CKD）女性患心血管疾病（CVD）及死亡的风险高于男性，尽管尚未明确导致该较高风险的潜在机制。我们评估了CKD儿童在以下两方面的性别差异：（1）CVD危险因素及左心室肥厚（LVH）；（2）左心室质量（LVM）与不同身体尺寸测量指标之间的关系。
设计、地点、参与者及测量方法：研究人群包括来自儿童慢性肾脏病队列的681例CKD儿童，共进行了1330次访视。按性别对CVD危险因素进行横断面比较。LVH定义为LVM/身高>第95百分位数，且LVM相对于年龄和性别的估计去脂体重（eLBM）>第95百分位数。使用双变量和多变量回归模型，通过调整年龄、体重、身高和eLBM来评估LVM的性别差异。
与男孩相比，女孩发生未控制高血压的可能性较小（26%对38%，P = 0.001），舒张压z评分较低（+0.3对+0.6，P = 0.001），高甘油三酯患病率较低（38%对47%，P = 0.03）。当根据身高校正的LVM定义LVH时，女孩LVH患病率较高（16%对9%，P = 0.01）；当根据相对于eLBM的LVM定义LVH时，女孩和男孩的LVH患病率相似（18%对17%，P = 0.92）。在调整eLBM的回归模型中，未观察到LVM的性别差异。
尽管CVD危险因素的患病率未增加，但根据身高校正的LVM显示女孩中LVH的比例较高，而基于eLBM的LVH估计未显示性别差异。在CKD儿童中，将LVM根据eLBM进行校正可能是根据身高校正的一种替代方法。
