Study of tumor necrosis factor-α, soluble tumor necrosis factor receptor-1 levels and its role in intravenous immunoglobulin non-responsive children with Kawasaki disease

Abstract

Objective To investigate the outcome of intravenous immunoglobulin (IVIG) therapy in children with Kawasaki disease(KD), and to study serum tumor necrosis factor-α (TNF-α), soluble tumor necrosis factor receptor-1 (sTNFR1) levels in these patients, and to explore further treatment of IVIG non-responsive. Methods Eighty-three patients with KD received initial IVIG and aspirin therapy within 10 days.Patients were divided into non-responsive group and sensitive group, while the clinical experiences and the outcome of them were recorded.Thirty-three health children were also recruited in this study, and the levels of serum TNF-α, sTNFR1 in KD patients were compared with health children and within different groups. Results 1.In non-responsive group, the rate of coronary artery lesions(CALs) was 45.4%(5/11 cases) in non-responsive group, but 33.3%(24/72 cases) in sensitive group, there was a statistical difference between them(P 0.05).3.Serum sTNFR1 concentration was (4.6±1.9) μg/L in non-responsive group, (4.7±2.9) μg/L in sensitive group, (5.4±1.9) μg/L in health children, so there was no statistical difference between them(P>0.05).4.In non-responsive group, serum TNF-α contentrations of CALs were significantly higher than non-CALs[(266.8±117.3) ng/L vs (126.2±93.7) ng/L], also significantly higher than serum TNF-α contentions of CALs in sensitive group[(118.8±96.1) ng/L], there was a statistical difference between them(P<0.05).5.In non-responsive group, but the levels of C-reactive protein(CRP) and lactate dehydrogenase(LDH) were higher than sensitive group, the levels of hemoglobin(Hb) and albumen were lower than sensitive group, so there was a statistical difference between them(P<0.05). Conclusions The high elevation of TNF-α levels existed in KD, also accompanied with abnormal sTNFR1 levels.The elevation of TNF-α levels had continually existed in non-responsive group after initial IVIG therapy.IVIG could let serum TNF-α concentrations down, so non-responsive group need additional IVIG therapy.The rate of CALs is more common in IVIG non-responsive group, but the outcome would be improved by using additional IVIG therapy.The high levels of CRP, LDH and low levels of Hb, albumen are closely asso-ciated with risk factors of IVIG re-treatment and inflammation reaction, so timely therapy is necessary to prevent damages in children with KD. Key words: Kawasaki disease; Intravenous immunoglobulin non-responsive; Tumor necrosis factor-α; Soluble tumor necrosis factor receptor; Coronary artery lesions