Korean Circ J.  2021 Mar;51(3):267-278. 10.4070/kcj.2020.0345.

IgA Levels Are Associated with Coronary Artery Lesions in Kawasaki Disease

• Kim JJ
• Kim HJ
• Kim JJ
• Yun SW
• Lee KY
• Yoon KL
• Kil HR
• Kim GB
• Han MK
• Song MS
• Lee HD
• Jun HO
• Ha KS
• Hong YM
• Jang GY
• Lee JK
• he Korean Kawasaki Disease Genetics Consortium

• KMID: 2513525
• DOI: http://doi.org/10.4070/kcj.2020.0345

Abstract

Background and Objectives
Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined.
Methods
Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease.
Results
Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs). Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022).
Conclusions
High IgA levels in patients with KD are prognostic for the risk of CALs.

Keyword

Mucocutaneous lymph node syndrome; IgA; Coronary aneurysms

Figure

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  Figure 1 Distribution of Ig levels according to the sampling time point. (A) IgG, (B) IgA, (C) IgM, and (D) IgE levels were classified as low, normal, or high according to the reference values for each Ig. The percentage of each Ig during the different disease phases (acute, n=56; subacute, n=157; convalescent, n=7; normal, n=21) is presented.Ig = immunoglobulin.

• 

  Figure 2 Correlation between CAL size and (A) IgA and (B) IgM levels during the acute and subacute phases of KD. The largest internal diameters of coronary arteries were plotted against (A) IgA and (B) IgM levels. IgA and IgM levels correlated significantly with CAL size (IgA: r=0.435, p<0.001; IgM; r=0.272, p<0.001).CAL = coronary artery lesion; Ig = immunoglobulin; KD = Kawasaki disease.

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