文章摘要
张依菡,吴蓉洲,胡军勇,金增游,叶泽豪,仇慧仙,褚茂平,施红英.不同性别川崎病患儿冠状动脉损害风险差异的内在机制[J].中华流行病学杂志,2019,40(12):1634-1638
不同性别川崎病患儿冠状动脉损害风险差异的内在机制
The mediation mechanism of coronary artery lesions in both male and female patients with Kawasaki disease
收稿日期:2019-05-22  出版日期:2019-12-20
DOI:10.3760/cma.j.issn.0254-6450.2019.12.024
中文关键词: 川崎病  冠状动脉损害  中介分析
英文关键词: Kawasaki disease  Coronary artery lesions  Mediation analysis
基金项目:浙江省自然科学基金(LY19H260004);浙江省软科学计划(2018C35020);国家自然科学青年基金(81502893);浙江省大学生科技创新活动计划(新苗人才计划)(2018R413008)
作者单位E-mail
张依菡 温州医科大学公共卫生与管理学院预防医学系 325035  
吴蓉洲 温州医科大学附属第二医院儿童心脏中心 325027  
胡军勇 温州医科大学 325035  
金增游 温州医科大学附属第一医院 325000  
叶泽豪 温州医科大学公共卫生与管理学院预防医学系 325035  
仇慧仙 温州医科大学附属第二医院儿童心脏中心 325027  
褚茂平 温州医科大学附属第二医院儿童心脏中心 325027 chmping@hotmail.com 
施红英 温州医科大学公共卫生与管理学院预防医学系 325035 shying918@163.com 
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中文摘要:
      目的 探讨不同性别川崎病患儿冠状动脉损害(CAL)风险差异的内在机制。方法 选择温州医科大学附属育英儿童医院2009年1月至2014年12月期间全部确诊川崎病患儿,根据患儿性别比较两组人口学特征、临床表现、实验室指标、治疗方案与时间以及治疗前后超声心动图检查结果。在控制各种混杂因素后评估性别对于CAL发生风险的独立效应,分析BMI、就诊时间、川崎病类型对该关联性的中介效应及其比例。结果 男童BMI水平高于女童,差异有统计学意义(P<0.001);男童超重比例(20.9%)高于女童(14.1%),差异有统计学意义(P=0.011)。多因素logistic回归分析显示,性别是CAL的独立影响因素,男童CAL发生率较高(aOR=1.50,95% CI:1.06~2.12),并主要体现在丙球治疗前。中介分析结果显示,BMI是性别影响CAL路径中重要的中介因子[中介效应为1.05(95% CI:1.01~1.10),中介比例为13.0%]。结论 男童CAL发生风险较高,并主要体现在丙球治疗前;超重可能是男童CAL发生率高的中介因子。
英文摘要:
      Objective To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children. Methods 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. Results The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (P<0.001). The prevalence of overweight among male patients (20.9%) was higher than female (14.1%). The difference was statistically significant (P=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 (aOR=1.50, 95% CI: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% CI:1.01-1.10) and the proportion mediated as 13.0%. Conclusions 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.
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