가와사키병에서 정맥 면역글로불린 반응도에 따른 면역글로불린G 수용체 아형에 관한 연구

다국어 초록 (Multilingual Abstract)

Purpose: Kawasaki disease (KD) is an acute systemic vasculitis that first introduced at Japan in 1967, and a high morbidity in Asian. Most of patients with KD respond to IVIG and alleviate a fever. However, a part of patients with KD (10~20%) may persist a fever after IVIG therapy and have a coronary artery lesion. The action of IVIG in patients with KD may relate to an immunomodulatory and anti-inflammatory mechanism. There have been few studies on the clinical comparison study for the responsiveness of IVIG therapy according to the level of IgG and expression of FcγRs in patients with KD. We studied that an change of IgG and CD14+CD16+ level in patients with KD after IVIG therapy, and a comparison between responder and non-responder group.
Methods: One hundred and forty four patients with acute KD to Chungnam National University Hospital between April 2004 and September 2009 were included in this study. Ten children consistent with an age, weight and height with KD group enrolled as control group. IVIG was infused intravenously by 2g/kg during 12 hours. Non-responder group of IVIG was defined as patients who had a fever persisted for 48 hours or reoccurred after 48 hours. Patients with KD were examined the ventricular function and coronary artery lesion by echocardiography. The levels of serum immunoglobulin and CD14+CD16+ were measured before, at 1 day, and 1 month after IVIG therapy. The levels of CD14+CD16+ were measured by means of flow cytometry and analyzed using FACScan.
Results: One hundred ten patients of them who were measured the level of IgG, IgA, IgM, and IgE according to IVIG therapy and composed of 103 responder group and 7 non-responder group. The levels of IgG in serum were higher in responder group than non-responder before and after IVIG therapy. Moreover, the change of IgG after IVIG therapy was higher in responder group. There is no difference in the levels of IgA, IgM, and IgE between responder and non-responder group. The levels of CD14+CD16+ in patients with KD before IVIG was higher than control group significantly. (P value 0.047) There was a difference in the level between before IVIG and at 1 month after IVIG (P value 0.022), but was not between before IVIG therapy and at 1 day after IVIG. (P value 0.092) There is no difference in the ratio and cell count of CD14+CD16+ between responder and non-responder group before IVIG therapy. (P value 0.682 and 0.454) Also, there is no difference at 1 day after IVIG therapy.
Conclusion: The levels of IgG in responder group are significantly higher than non-responder group. The expression of FcγRIII that mainly considered to mediating the immunomodulatory effects of IVIG was higher in patients with KD than control group. However, there is no difference between responder and non-responder group. A prospective comparison study for other factors is required to confirmation.

목차 (Table of Contents)

• I. 서 론 1
• II. 대상 및 방법 5
• III. 결 과 10
• IV. 고 찰 14
• V. 결 론 30
• VI. 참고 문헌 32
• Abstract 49