Watelle Laurence, Dahoud Andrea, Blais Samuel, Scuccimarri Rosie, Renaud Claudia, McCrindle Brian W, Human Dereck, Dallaire Frédéric, Dahdah Nagib
Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Pediatric Cardiology Division, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Paediatr Child Health. 2025 Apr 3;30(4):250-256. doi: 10.1093/pch/pxae106. eCollection 2025 Jul.
Kawasaki disease (KD) is the leading cause of acquired childhood coronary aneurysms (CAA). Males are more affected than females, with lower survival from cardiac events and normalization rates. This study aimed to determine the association between biological sex and CAA risk and evaluate the association with baseline biochemical inflammatory markers by biological sex.
This multicenter retrospective cohort study involved children ≤10 years old diagnosed with KD in five Canadian centres. Adjusted CAA risk differences between sexes were computed using binomial regression. Associations between inflammatory markers and CAA risk were analyzed using logistic regression with interaction terms between sex and inflammatory markers.
From 2004 to 2015, 1382 patients were diagnosed with KD and 812 (59%) were males. Median age, fever total duration, and fever duration at therapy initiation were similar between the sexes. The cumulative incidence of medium to large (Z ≥ 5) CAA was higher in males [70/812 (8.6%)] compared to females [19/570 (3.3%)], with an adjusted risk difference of 4.6 % (95% confidence interval [CI] 2.1 to 7.1). Large (Z > 10) aneurysms were more prevalent in males (adjusted risk difference of 3.3%, 95% CI 1.7 to 5.0). Most inflammatory markers were positively associated with CAA risk, but the association was not statistically different between sexes.
Males with KD are at higher risk of developing CAA compared to females. The majority of patients were presumed to be prepubertal, suggesting that hormonal influences are unlikely to be a significant factor. Future KD research based on biological sex categorization should focus on patient risk stratification and long-term prognostic evaluation.
川崎病（KD）是儿童后天性冠状动脉瘤（CAA）的主要病因。男性比女性受影响更严重，心脏事件的生存率和恢复正常率较低。本研究旨在确定生物学性别与CAA风险之间的关联，并按生物学性别评估与基线生化炎症标志物的关联。
这项多中心回顾性队列研究纳入了加拿大五个中心诊断为KD的10岁及以下儿童。使用二项式回归计算性别之间调整后的CAA风险差异。使用逻辑回归分析炎症标志物与CAA风险之间的关联，并分析性别与炎症标志物之间的交互项。
2004年至2015年，1382例患者被诊断为KD，其中812例（59%）为男性。两性之间的中位年龄、发热总持续时间和开始治疗时的发热持续时间相似。男性中、大型（Z≥5）CAA的累积发病率[70/812（8.6%）]高于女性[19/570（3.3%）]，调整后的风险差异为4.6%（95%置信区间[CI]2.1至7.1）。大型（Z>10）动脉瘤在男性中更为普遍（调整后的风险差异为3.3%，95%CI 1.7至5.0）。大多数炎症标志物与CAA风险呈正相关，但两性之间的关联无统计学差异。
与女性相比，患KD的男性发生CAA的风险更高。大多数患者被认为是青春期前的，这表明激素影响不太可能是一个重要因素。未来基于生物学性别分类的KD研究应侧重于患者风险分层和长期预后评估。
