The Clinical Significance of Soluble Intercellular Adhesion Molecule-1 (sICAM-1) and Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) in Kawasaki Disease / 소아과

ABSTRACT

PURPOSE: Kawasaki disease (KD) is known as an acute multi-systemic vasculitis with various immunologic abnormalities. Adhesion of leukocyte to endothelial cells is a key event in the sequence of inflammatory response. This study was performed to investigate the clinical significance of serum soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in acute and subacute stages of typical KD for diagnostic and prognostic value. METHODS: A typical KD group was 32 patients who were hospitalized from Jan 2002 to Jun. 2004 was enrolled. Control was 16 non-KD patients with febrile illness. sICAM-1 and sVCAM-1 were measured and compared by Echocardiographic and clinical findings and cardiac troponin T and I. RESULTS: sICAM-1 and sVCAM-1 levels of acute KD were significantly elevated over control (P= 0.019 vs. P=0.049, respectively) and sICAM-1 was significantly decreased in subacute stage (P= 0.0015). sICAM-1 and sVCAM-1 had positive correlation with each other in both stages (P=0.0067, P=0.015, retrospectively). Neither sICAM-1 nor sVCAM-1 correctly reflected the coronary abnormalities and responsiveness to intravenous gammaglobulin (IVGG) in both stages. But sVCAM-1 was significantly increased in the carditis group in both stages (P=0.025, P=0.014, retrospectively) and had a positive correlation with troponin T (r=0.63, P=0.00063). CONCLUSION: The levels of sICAM-1 and sVCAM-1 were not very useful tools for detecting and predicting subsequent coronary abnormalities and responsiveness to IVGG in KD patients. However, sVCAM-1 appears to play a significant role in carditis of KD. Further studies are needed about various adhesion molecules and cytokines in the pathogenesis of KD.