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MR Vol.14 No.1 indexに戻る
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MODERN RHEUMATOLOGY
Vol.14 No.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 |
| 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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