Jae Jung Kim1, Hea Ji Kim1, Jeong Jin Yu2, Sin Weon Yun3, Kyung Yil Lee4, Kyung Lim Yoon5, Hong Ryang Kil6, Gi Beom Kim7, Myung Ki Han8, Min Seob Song9, Hyoung Doo Lee10, Hyun Ok Jun11, Kee Soo Ha12, Young Mi Hong13, Gi Young Jang14, Jong Keuk Lee15. 1. Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 3. Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea. 4. Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea. 5. Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea. 6. Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea. 7. Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. 8. Department of Pediatrics, University of Ulsan, Gangneung Asan Hospital, Gangneung, Korea. 9. Department of Pediatrics, Inje University Paik Hospital, Busan, Korea. 10. Department of Pediatrics, Pusan National University Hospital, Busan, Korea. 11. Department of Pediatrics and Adolescent Medicine, Myongji Hospital, Goyang, Korea. 12. Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea. 13. Department of Pediatrics, Ewha Womans University Hospital, Seoul, Korea. 14. Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea. 15. Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea. cookie_jklee@hotmail.com.
Abstract
BACKGROUND AND OBJECTIVES: Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined. METHODS: Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease. RESULTS: Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs). Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022). CONCLUSIONS: High IgA levels in patients with KD are prognostic for the risk of CALs.
BACKGROUND AND OBJECTIVES:Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined. METHODS: Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease. RESULTS: Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs). Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022). CONCLUSIONS: High IgA levels in patients with KD are prognostic for the risk of CALs.