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KMID : 0857220040080020404
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Journal of the Korean Pediatric Cardiology Society
2004 Volume.8 No. 2 p.404 ~ p.411
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The Impact of Immune Globulin Dose Difference on the Cardiovascular Manifestation in Kawasaki Disease
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Cho Jae-Ju
Jung Mi-Jin
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Abstract
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Purpose: The effect of intravenous immune globulin(IVIG) on the incidence of coronary arterial aneurysm in Kawasaki disease is well known. However, the dosage of the immune globulin is still on a controversy. The purpose of this study was to evaluate the impact of immune globulin dose difference on the cardiovascular manifestation in Kawasaki disease.
Methods: We performed 2-dimensional, M-mode, and Doppler echocardiogram to evaluate coronary arterial aneurysm, myocardial performance, and diastolic function before(pre) and after IVIG treatment(period 1, 2, 3). From Aug. 2002 to Dec. 2003, 61 patients were given 1 g/kg or 2 g/kg of IVIG randomly. Among 26 patients of 1 g/kg users, 23 patients(group 1) were successful with one dose and among 35 patients of 2 g/kg users, 24 patients(group 2) were so. 14 patients(group 3) not relieved from fever with one dose were prescribed further 1 g/kg of IVIG repeatedly until the fever subsided.
Results: The duration from the start of IVIG infusion to the defervescence below 37 ℃ was different between group 1, 2 and group 3(29, 35, 113 hours respectively, P < 0.001). Total 7 cases showed the coronary arterial aneurysm(CA) and no statistical difference between groups(group 1,2,3; 1/23, 3/24, 3/14 cases). In group 1 and 2, CA developed before IVIG start but thereafter in group 3 and all cases of CA were less than 4 mm in internal diameter. Retreatment rate of 1 g/kg users was less than that of 2 g/kg users(3/26; 12%, 11/35; 31%) but statistically not significant. There was not any statistical difference in the myocardial function between groups. Average Harada score was similar in both CA cases and the patients with normal coronary arteries but a little bit high in group 3 compared to group 1 and 2(group 1, 2, 3:3.7, 3.9, 4.5, P>0.05).
Conclusion: 1 g/kg of IVIG users showed comparable outcome to 2 g/kg IVIG users in terms of CA prevalence, myocardial function, and retreatment rate.
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KEYWORD
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Kawasaki disease, Immune globulin dose, Coronary arterial aneurysm, Myocardial function, Retreatment
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