Effect of corticosteroids in addition to intravenous gamma globulin therapy on serum cytokine levels in the acute phase of Kawasaki disease in children

OBJECTIVE: The aim of this multicenter prospective and randomized study was to determine the effect of adding corticosteroids to intravenous gamma globulin (i.v.GG) therapy on serum cytokine levels, as well as to see its effect on the clinical course in children in the acute phase of Kawasaki disease (KD). STUDY DESIGN: Patients with KD (n=32) were randomized to receive either i.v.GG alone (G group) or i.v.GG plus corticosteroids (G+S group). The clinical course and cytokine responses between groups were compared. RESULTS: The pretreatment serum levels of interleukin (IL)-2, IL-6, IL-8, and IL-10 were significantly higher in patients with KD than in healthy controls. Although i.v.GG alone failed to reduce cytokine concentrations within 24 hours of i.v.GG administration, corticosteroids plus i.v.GG reduced IL-2, IL-6, IL-8, and IL-10 levels. The levels of IL-2, IL-6, IL-8, and IL-10 within 24 hours after initiating i.v.GG therapy were significantly lower in the G+S group than in the G group. The duration of fever was shorter, and the C-reactive protein concentration decreased more quickly in the G+S group than in the G group. CONCLUSIONS: These findings suggest that corticosteroids rapidly ameliorate symptoms by reducing cytokine levels in children with KD.     

A polymorphism in plasma platelet-activating factor acetylhydrolase is involved in resistance to immunoglobulin treatment in Kawasaki disease

OBJECTIVE: To investigate whether reduced levels of plasma platelet-activating factor acetylhydrolase (PAF-AH) as a result of a genetic polymorphism are involved in the pathogenesis of Kawasaki disease (KD). STUDY DESIGN: The frequency of a V279F polymorphism (G/T transversion) in the PAF-AH gene was quantified in 76 Japanese children with KD and 112 healthy Japanese adults using the allele-specific polymerase chain reaction (PCR). Associations between genotype, clinical features, and resistance to intravenous immunoglobulin (IVIG) were investigated in the patients with KD. Plasma PAF-AH activity was measured by using [3H]-acetyl-PAF. RESULTS: There were no significant differences in genotype frequency between patients and controls (P = .51). Compared with the GG (normal genotype) group, significantly more patients in the GT (heterozygous) +TT (homozygous deficient) group required additional IVIG (52% vs 14%, P = .001). The duration of fever and maximum serum C-reactive protein (CRP) levels also were significantly increased in the GT+TT group (P = .012 and .036, respectively), whereas plasma PAF-AH activity was significantly lower (P <.0001). CONCLUSION: We conclude that the V279F polymorphism in the plasma PAF-AH gene and consequent enzymatic deficiency is one of the factors for IVIG nonresponse in Japanese patients with acute KD.     

CD14基因多态性和川崎病冠状动脉损伤之间关系的研究

目的探讨脂多糖受体CD14基因多态性和川崎病(KD)冠状动脉损伤之间的关系。方法研究对象为2006年10月至2007年10月在南京儿童医院住院治疗的KD患儿,采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)分析方法检测76例KD儿童和118例健康对照儿童CD14基因-260C/T位点基因型频率和等位基因频率及其与KD冠状动脉损伤之间的关系;应用酶联免疫吸附实验(ELISA)检测二组儿童血清总TNFα的浓度。结果KD组血清TNFα水平[(73.9±21.7)ng/mL]高于对照组[(19.36±8.25)ng/mL],差异有统计学意义(t=2.047,P<0.05)。KD组和健康对照组CD14基因(-260C/T)CC,CT,TT基因型分布分别为35.5%、30.3%、34.2%和38.1%、47.5%、14.4%(χ2=11.62,P<0.05),差异有统计学意义;其C、T等位基因频率则分别为50.7%、49.3%和61.9%,38.1%(χ2=4.76,P<0.05),差异有统计学意义;其基因型频率和等位基因频率在KD冠脉损伤组和未损伤组之间比较差异无统计学意义(χ2=0.921,P>0.05)。但其等位基因频率的相对风险分析发现T等位基因携带者发生冠脉损伤的风险是C等位基因的1.256倍。结论CD14基因(-260C/T)多态性与KD相关,T等位基因可能是KD冠脉损伤的遗传易感因素。     

CD25+CD4+ regulatory T cells in patients with Kawasaki disease

OBJECTIVE: To investigate whether the CD25 + CD4 + regulatory T-cell population, which plays important roles not only in maintaining immunologic self-tolerance but also in controlling the magnitude and character of antimicrobial immune responses, is related to the pathophysiology of Kawasaki disease (KD). STUDY DESIGN: The patient group consisted of 54 patients (median age, 30 months; 27 female and 27 male patients) fulfilling the criteria for KD. Age-matched control subjects included 17 patients with active infections and 24 healthy children. We analyzed CD25 + CD4 + cells and the mRNA expression of Foxp3, cytotoxic T lymphocyte-associated antigen 4 (CTLA4), glucocorticoid-induced tumor necrosis factor receptor (GITR), and transforming growth factor beta in peripheral blood mononuclear cells and purified CD4 + T cells. RESULTS: The proportions of CD25 + CD4 + cells in patients with acute-phase KD (median, 2.35% of total lymphocytes) were significantly lower than those in healthy control subjects (median, 3.14%) and control subjects with disease (median, 3.15%). The proportions returned to the normal level after intravenous gammaglobulin treatment (median, 3.86%). The mRNA expression of Foxp3, CTLA4, and GITR showed similar tendencies. CONCLUSIONS: The decrease of CD25 + CD4 + regulatory T cells in the acute phase might have a role in the development of KD.     

TGFBR2基因多态性与川崎病和冠状动脉损伤相关性的研究

目的 检测儿童转化生长因子β受体2(TGFBR2)基因多态性(rs1495592)的分布情况,并探讨其与川崎病及冠状动脉损伤的相关性。方法 应用基因测序技术对35例川崎病患儿(14例并发冠脉损害)的TGFBR2基因多态性(rs1495592)进行研究,另取25例正常同龄儿作对照。结合测序结果分析此多态性与川崎病及冠状动脉损伤的相关性。结果 病例组中基因型分布和等位基因频率分布与对照组相比差异均无统计学意义(分别χ2=0.566、0.216,分别P=0.452、0.642)。冠状动脉损害组基因型分布(CC 21.4%,CT+TT 78.6%)与非冠状动脉损害组基因型分布(CC 61.9%,CT+TT 38.1%)差异有统计学意义(χ2=5.546,P=0.019),而两组等位基因频率分布差异无统计学意义(χ2=3.673,P=0.055)。结论 儿童中TGFBR2基因多态性(rs1495592)可能与川崎病的发生无相关性,但与川崎病患儿的冠脉损害发生相关。