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The effects of high-dose intravenous immunoglobulin on plasma protein and lipid levels in the patients with Kawasaki disease

Korean Journal of Pediatrics 2006;49(12):1348-1353.
Published online December 15, 2006.
The effects of high-dose intravenous immunoglobulin on plasma protein and lipid levels in the patients with Kawasaki disease
Keun Young Lee, Dong-Un Kim, Hyun Seung Lee, Pil Sang Jang, Young-Hoon Kim, Jin Tack Kim, Hyun Hee Kim, Kyung-Yil Lee, Joon-Sung Lee
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
가와사끼병에서 고용량 정맥용 면역글로불린이 혈장 단백 및 지질에 미치는 영향(면역글로불린 투여 후 단백질 농도 변화)
이근영, 김동언, 이현승, 장필상, 김영훈, 김진택, 김현희, 이경일, 이준성
가톨릭대학교 의과대학 소아과학교실
Dong-Un Kim, Email: dukim@catholic.ac.kr
: The reticuloendothelial system is composed of sinusoidal capillaries, through which even large protein molecules are freely movable between plasma and interstitial space, including the lymphatic system. Therefore, high-dose intravenous immunoglobulin (IVIG) would cause a redistribution of proteins between two compartments. To investigate this hypothesis, we measured plasma protein and lipid levels in patients with Kawasaki disease before and after high-dose IVIG treatment.
: Thirty four children with Kawasaki disease who had complete responses to high-dose IVIG treatment (1 g/kg/day for two consecutive days), were analyzed. Before and after the administration of IVIG, serum analyses were performed for such parameters as total protein, albumin, γ- globulins (IgG, IgM, IgA), α1-, α2-, and β- globulin fractions, and lipid profiles (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride).
: The levels of γ-globulins including IgG, IgM, IgA were significantly increased, and IgG was increased by 1,779±304 mg/dL after two-dose of IVIG infusion. The levels of albumin, α1-, α2-, and β globulin fractions were significantly decreased by 18 percent, 24 percent, 19 percent and 12 percent, respectively. HDL-cholesterol level was significantly decreased by 20 percent, while LDL- cholesterol and triglyceride levels were significantly increased by 21 percent and 50 percent, respectively. The total cholesterol level was not changed.
: High-dose IVIG treatment decreased the levels of a variety of proteins except immunoglobulins, and the increase of IgG after IVIG treatment was lower than expected. Our results suggest that a part of infused IVIG and plasma proteins, including etiologic proteins for Kawasaki disease, may be distributed to the extravascular compartments. The rapid improvement of symptoms induced by IVIG in Kawasaki disease might be explained by this mode of action of IVIG.
Key Words: Intravenous immunoglobulin , Mucocutaneous lymph node syndrome , Plasma protein , Plasma lipid

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