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MODERN RHEUMATOLOGY Vol.14 No.1
>MR14-1
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| Efficacy of plasma exchange therapy for Kawasaki disease intractable to intravenous gamma-globulin |
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| Masaaki Mori1 , Tomoyuki Imagawa1, Shigeki Katakura1, Takako Miyamae1, Ken-ichi Okuyama1, Shuichi Ito1, Tomoko Nakamura1, Hirokazu Kimura2 and Shumpei Yokota1 |
(1) Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
(2) Department of Public Health, Yokohama City University School of Medicine, Yokohama, Japan |
Received: 24 April 2003 Accepted: 05 August 2003 |
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Abstract |
| Abstract Kawasaki disease (KD) causes coronary artery lesions (CALs) in 500 Japanese children each year. Intravenous gamma-globulin (IVGG) decreases the incidence of these lesions from 25% to 8% of the total KD cases. We examined whether plasma exchange is a safe and effective prophylaxis against CALs in children with KD intractable to IVGG therapy. Eighty-nine children with KD at high risk of CALs were selected on the basis of increases in fractional changes in inflammatory markers such as white blood cell count, neutrophil count, and C-reactive protein between the baseline and 1?2 days after IVGG treatment. Of 105 children who received a second course of IVGG therapy because the initial course was ineffective, plasma exchange (PE) was performed in 46 children who had not responded to the second IVGG treatment. The outcome was compared with the results when a third course of IVGG therapy was given to the other 59 children. No complications occurred with the plasma exchange therapy. CALs developed in only 8 of the 46 children (17.3%) who underwent plasma exchange, but they occurred in 24 of the 59 (40.7%) who had received a third course of IVGG therapy (P 0.0012). We concluded that PE was a safe, effective prophylactic measure against CALs in children with KD intractable to IVGG therapy. PE should be performed at an early stage, as soon as fractional increases in inflammatory markers are found after IVGG therapy. |
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| Key words |
| Key words Coronary artery lesion (CAL) - Efficacy - Intravenous gamma-globulin (IVGG) - Kawasaki disease (KD) - Plasma exchange (PE) |
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