Abstract
Background: Immunoglobulins(Ig), such as IgA, have been found in affected coronary arteries in Kawasaki Disease(KD). Changes in Ig may reflect the development of coronary artery lesions(CAL). Objectives: To characterize changes in serum Ig during the course of KD and to determine whether Ig were predictive of coronary outcome. Methods: 243 KD pts(1995-2001) were included in this retrospective study. Data retrieved consisted of demographics and clinical course including lab tests from pre-treatment to 1yr post KD diagnosis(i.e. pre/post-IVIG, subacute, convalescent, 1yr). The quantitative variables were tested for their significance using the Student t test. Results: The mean age of pts was 3.7±2.8yrs. 66.3% were males and 33.7% were females. All received IVIG(2g/kg) and ASA. 19.3% required adjunctive therapy(multiple IVIG±corticosteroids). CAL detected at KD diagnosis, 3mos and 1yr comprised of ectasias (49.0%,31.3%,14.0%), aneurysms(3.3%,2.9%,1.2%) and giant aneurysms(0%,0.4%,0%). 93 pts had paired pre/post-IVIG Ig. Immediately post IVIG, the mean change in Ig was an increase IgG(70.9±16.8%), IgM(2.3±21.2%) and a decrease IgA(-8.5±20.4%). 43 pts had paired pre/subacute Ig. In this case, the mean change in Ig was an increase IgG(34.8±47.7%), IgM(13.7±36.4%) and a decrease IgA(-15.4±65.1%). No significant differences were noted in pts with giant aneurysms and Ig levels. Significant serologic markers associated with CAL were decreased subacute IgG&IgA(acute ectasias), increased post-IgG&decreased pre/post-IgM(persistent ectasias), and increased pre/convalescent-IgA&convalescent-IgG(persistent aneurysms). Consistent with Harada's risk factors, a lower PLT(p=0.04) and higher ESR(p=0.008) were associated with CAL. Persistent CAL were associated with a lower albumin(p=0.02) and a larger fall in the WBC post-IVIG(p=0.03). Conclusions: The natural history of Ig post IVIG in KD pts was an increase IgG and IgM and a fall in IgA. Patients with acute CAL had lower subacute IgA and IgG. In contrast, pts with persistent CAL had higher IgA pre-IVIG, higher IgG post-IVIG, lower IgM pre and post-IVIG, and higher convalescent IgG & IgA.
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Tse, S., Yeung, R. Kinetics of Serum Immunoglobulins in Kawasaki Disease: Are They Predictors for Coronary Outcome?. Pediatr Res 53, 180 (2003). https://doi.org/10.1203/00006450-200301000-00159
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DOI: https://doi.org/10.1203/00006450-200301000-00159