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KMID : 0350519960490010375
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Journal of Catholic Medical College
1996 Volume.49 No. 1 p.375 ~ p.386
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Immunoregulatory Effect of Intravenous Immunoglobulin in Kawasaki Disease
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Abstract
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It has been suggested that immunologic abnormalities play a role in the pathogenesis of vascular injury in Kawasaki disease and the immunologic abnormalities could be regulated by high-dose intravenous immunoglobulin (IVIG).
The authors investigated the peripheral blood lymphocyte subsets, the serum levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and the effect of high-dose IVIG(400mg/kg/day for 5 days) on these factors at the acute stage of Kawasaki
disease.
Thirty patients, aged 4 months to 5 years, who met the diagnostic criteria for Kawasaki disease were enrolled in this study. Patients were divided into two groups, Kawasaki disesase with coronary vascular lesion (KD-CVL, n=15) and without
coronary
vascular lesion (KD-NCVL, n=15). Percentages of peripheral blood lymphocyte subsets were neasured by flow-cytometry and the serum levels of IL-6 and TNG-α were measured by ELISA on 1 day after administration of IVIG and compared with the normal
control
group (N|n=15).
@ES The results were as follows;
@EN 1. At the acute stage of Kawasaki disease, the percentages of CD3+lymphocyte and CD8_lymphocyte in both KD-CVL and KD-NCVL groups were significantly lower and the percentages of CD19+lymphocyte and CD4+/CD8+ratio in both KD-CVL and KD-NCVL
groups
were significantly higher than those in the control group. There was no significant difference between the percentages of CD4+lymphocyte in both groups and that in the control group but compared with absolutely decreased CD8+lymphocyte,
CD4+lymphocyte
was relatively increased in Kawasaki disease.
2. At the acute stage of Kawasaki disease, the detection rates and mean serum levels of IL-6 and TNF-α in both KD-CVl and KD-NCVL groups were significantly higher than those of the control group. There was no significant difference between the
serum
level of IL-6 in KD-CVL group and that in KD-NCVL group but the serum level of TNF-α in KD-CVL group significantly higher than that in KD-NCVl group.
3. By administration of IVIG, the percentages of CD3+lymphocyte and CD8+lymohocyte in both KD-CVL and KD-NCVL groups were significantly increased and the percentages of CD19+ lymphocyte and CD4+/CD8+ratio in both KD-CVL and KD-NCVL groups were
significantly decreased to the level of the control group.
4. By administration of IVIG, the detection rates of serum IL-6 and TNF-α in KD-CVL group were not lowered, which were significantly decreased in KD-NCVL group. In KD-NCVl group, the detection rate and mean serum level of IL-6 were still higher
than
those in the control group but the detection rate and mean serum level of TNF-α were decreased to the level of the control group.
In conclusion, immunologic abnormalities including decreased percentages of CD3+lymphocyte, CD8+lymohocyte, increased percentages of CD19+lymphocyte and CD4+/CD8+ratio and increased levels of IL-6 and TNF-α were noted at the acute stage of
Kawasaki
diseases. If this hyperactivated immunologic system might be repaired by IVIG, the occurrence of coronary vascular lesion could be prevented. It the serum levels of IL-6 and TNF-α were continuously elevated, the risk of the occurrence of
coronary
vascular lesion would be increased.
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KEYWORD
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