All issues > Volume 33(10); 1990

Original Article

J Korean Pediatr Soc. 1990;33(10):1380-1387. Published online October 31, 1990.

Comparison between Treatment with Aspirin Alone and the Combined Treatment with Aspirin and Intravenous gamma-Globulin in Kawasaki Disease.

Sang Yoon Ahn¹, Sun Yang Hong¹, Nam Soo Kim¹, Ha Baik Lee¹, Soo Jee Moon¹, Hahng Lee¹

¹Department of Pediatrics, College of Medicine, Hanyang University Hospital, Seoul, Korea

Received: May 17, 1990;  Accepted: July 24, 1990.

Abstract

Out of a total of 140 children hospitalized with the diagnosis of Kawasaki disease at the Depart- ment of Pediatrics, Hanyang University Hospital during the period of 9 years from July 1980 to July 1989, 68 cases were subjected to echcocardiographic examination at 10 to 15 days after the onset of illness, and these 68 cases were divided into two groups according the mode of therapy administered during the acute phase: 35 patients in Group A treated with a combination of intravenous /-globulin (400 mg/kg/day) and oral aspirin (80 ~ 100 mg/kg/day), and 33 patients in Group B treated with oral aspirin (80—100 mg/kg/day) alone. To investigate the effects of intravenous /-globulin on the clinical course of Kawasaki Disease, the frequency of echocardiograhpic abnormalities at 10 to 15 days of the illness, the illness, the duration of febrile illness, and the changes in the total white blood cell counts, platelet counts, and erythrocyte sedimentation rates (ESR) at 1 and 2 weeks of the illness were studied and the results were compared between the two groups. The results of the study are as follows: 1) The age and sex distribution was comparable in both groups: The mean age was 25.4 ±22.3 months for Group A and 23.6 ±18.6 months for Group; and there were 20 boys and 15 girls in Gorup A and 21 boys and 12 females in Group B. 2) Aspirin was started orally at 5.2±0.8 days after the onset of the illness in Group A and at 4.8± 0.4 days after the onset in Group B. Intravenous /-globulin was started at 6.3 ±0.8 dayss after the onset and continued for five days in Group A. The duration of the febrile period after the initiation of the therapy was significantly shorter in Group A than in Group B with 3.1 ±0.5 days in Group A and 5.4±0.6 days in Group B (p<0.005). 3) No significant difference was noted in the platelet counts and in the ESRs in two groups, as measured at 1 and 2 weeks of the illness. However, the total white blood cell counts measured at 2 weeks after the onset was significantly lower in Group A with (9.0 ±0.7) X 103/mm3 in Group A and (11. 3±0.9)X 103/mm3 in Group B (p<0.05). 4) The echocardiographic abnormalities at 10 to 15 days after the onset were noted in 2 cases (5. 1%) out of 35 in Group A and in 6 cases (18.2%) out of 33 in Group B. There were one case of left coronary artery aneurysm and one case of left coronary artery dilatation in Group A; and 2 cases of left coronary artery aneurysms, 2 cases of left coronary artery dilatation, and 2 cases of pericardial effusion in Group B, when the coronary artery with the diameter of 3〜 5 mm was defined as the dilatation, and the diameter of over 6 mm or at 1.5 times wider than adjoining artery as the aneurysm, as measured by Hewlett Packard Series 40. The frequency of the echocardiographic abnormalities was less in Group A than in Group B, but the difference was not statistically significant in this study (p=0.144). In conclusion, the additive therapeutic effect of intravenous /-globulin in preventing the risk of cardiac abnormalities, such as coronary artery dilatation, aneurysm and pericardial effusion was not proven statistically significant in this study. Perhaps the small number of the patients studied and the short follow-up period might have been responsible for the lack of statistical significance. However, in order to justify the routine use of intravenous /-globulin at the current expensive costs in Korean children with Kawasaki Disease, further studies are indicated with more aggressive echocardiogra- phic studies, performed over the much longer follow-up period, and the therapeutic effect is yet to be proven unequivocally in Korean children.

Keywords :Kawasaki disease, Intravenous /-globulin