Oxygen Radicals Activity as a Predictor of Coronary Artery Lesions in Kawasaki Disease

Abstract

Background Neutrophil-derived Oxygen radicals (OR) play a role in a wide variety of diseases including vasculitis syndrome, however, little is known about causal relation between coronary artery lesions (CAL) in Kawasaki disease (KD) and OR activity.Objective To investigate a role of OR in CAL. Methods 27 patients with KD were enrolled within 7 days from the onset of illness. All patients were treated orally with aspirin (ASA), and 21 patients, selected by Harada scoring system, also received intravenous gammaglobulin therapy (IVGG). IVGG was administered as daily infusions of 200mg/Kg for five consecutive days. Patients were retrospectively divided into the following three groups according to IVGG and CAL: Severe group, patients with CAL treated with IVGG (n=3); Moderate group, patients without CAL treated with IVGG (n=18); and Mild group, patients without CAL not needed IVGG (n=6). 15 healthy children were studied as controls. Neutrophil-derived OR were measured as intracellular chemilluminescense (ICCL) of whole blood by luminol-dependent chemilluminescense method using luminol-binding microsheres. Serial changes in ICCL values were monitored from acute to convalescent phases in every patient.Results Significant differences were observed in pretreatment ICCL values among the three groups with KD (p<0.05). The mean ICCL values in mild, moderate and severe groups of KD were 13.7±5.5x105cpm, 34.8±9.3x105cpm, and 71.2±10.1x105cpm, respectively, while that in control was 3.1±1.2x105cpm (p<0.01). In IVGG groups, the ICCL values were significantly decreased at 1 and 4 weeks after treatment: 19.2±8.4x105cpm and 8.1±3.3x105cpm in moderate group (p<0.05), and 39.8±7.7x105cpm and 20.3±9.2x105cpm in severe group (p<0.05). Thus, patients with CAL (severe group) had persistently much higher ICCL values than patients without CAL (mild and moderate groups)(p<0.05).Conclusions OR activity was well correlated with severity of KD in acute phase and decreased in parallel with IVGG. OR activety appears to be useful for predicting the risk of CAL despite IVGG, and possibly helping earlier decision on an alternative treatment.