Zhang Y H, Wu R Z, Hu J Y, Jin Z Y, Ye Z H, Qiu H X, Chu M P, Shi H Y
Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China.
The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2019 Dec 10;40(12):1634-1638. doi: 10.3760/cma.j.issn.0254-6450.2019.12.024.
To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children. Children with KD that hospitalized in the Wenzhou Medical University affiliated Yuying Children's Hospital from January 2009 to December 2014, were included in this study. Differences on demographical characteristics, clinical manifestations, laboratory indicators, regimen and time of treatment, results from pre/post echocardiography and treatment between male and female patients, were compared. The independent effect of gender on the risk of coronary artery lesions (CAL) was evaluated, and the mediating effect of BMI, visiting time and KD type on the association between gender and CAL were also studied. The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (<0.001). The prevalence of overweight among male patients (20.9) was higher than female (14.1). The difference was statistically significant (=0.011). Data from the multivariate logistic regression analysis confirmed that the incidence of CAL in male patients was higher than that in female patients (a=1.50, 95: 1.06-2.12) but the CAL was mainly different before on the immunoglobulin therapy. Results from the mediation analysis showed that BMI was an important mediator in the association between gender and CAL, with the indirect effect as 1.05 (95: 1.01- 1.10) and the proportion mediated as 13.0. Male patients presented higher incidence of CAL but was mainly reflected in the difference of CAL before the treatment. BMI was probably an important mediator related to the association between gender and CAL.
探讨男性和女性川崎病（KD）患儿冠状动脉病变的中介机制。本研究纳入了2009年1月至2014年12月在温州医科大学附属育英儿童医院住院的KD患儿。比较了男性和女性患者在人口统计学特征、临床表现、实验室指标、治疗方案和时间、超声心动图检查前后结果及治疗情况等方面的差异。评估了性别对冠状动脉病变（CAL）风险的独立影响，并研究了BMI、就诊时间和KD类型在性别与CAL关联中的中介作用。男性患者的平均BMI水平高于女性患者。差异具有统计学意义（<0.001）。男性患者超重患病率（20.9）高于女性（14.1）。差异具有统计学意义（=0.011）。多因素逻辑回归分析数据证实，男性患者CAL的发生率高于女性患者（a=1.50，95%置信区间：1.06 - 2.12），但CAL主要在免疫球蛋白治疗前存在差异。中介分析结果表明，BMI是性别与CAL关联中的重要中介因素，间接效应为1.05（95%置信区间：1.01 - 1.10），中介比例为13.0。男性患者CAL发生率较高，但主要体现在治疗前CAL的差异上。BMI可能是与性别和CAL关联相关的重要中介因素。
