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윤경림,고진희,심계식,한미영,차성호,김수강,정주호 대한소아청소년과학회 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.8
Purpose: Hyperhomocysteinemia is known as a risk factor for atherosclerosis. Preclinical arteriosclerosis is noted and premature atherosclerosis is known to be accelerated in Kawasaki disease (KD)patients. Genetic polymorphisms in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene result in elevated plasma homocysteine concentrations and are known to be associated with the development of coronary artery disease. Our hypothesis is that single nucleotide polymorphisms (SNPs) of the MTHFR gene are related to the development of KD and coronary artery lesions (CALs). Methods: For this study, we selected 3 candidate single nucleotide polymorphisms (SNPs) (rs2274976, rs1801131, and rs1801133) of MTHFR . These SNPs are located on chromosome 1p36.3. We included 101 KD patients and 306 healthy adults as controls in this study. CALs were seen in 38 patients. Genotypes of the selected SNPs were determined by direct sequencing and analyzed with SNPAlyze. Results: The genetic distribution and allelic frequency of the 3 MTHFR SNPs (rs2274976, rs1801131, and rs1801133) were not significantly different in patients with KD compared to the control group (P=0.71,0.17, and 0.96, respectively). There was no difference in the genetic distribution of the MTHFR SNPs between the normal control group and the CAL group (P=0.43, 0.39, 0.52 respectively). Conclusion: The genetic distribution of the MTHFR SNPs (rs2274976,rs1801131, and rs1801133) was not different in the KD group compared to the control group. In addition, the genetic distribution of these SNPs was not different in the CAL group compared to the control group in the Korean population.
윤경림,이해용,유정진,이재영,한미영,김기용,허준 대한심장학회 2017 Korean Circulation Journal Vol.47 No.2
Background and Objectives: Intravenous immunoglobulin-SN (IVIG-SN) is a new human immunoglobulin product. Its safety is ensured by pathogen-elimination steps comprising solvent/detergent treatment and a nanofiltration process. This multicenter clinical study was designed to evaluate the efficacy and safety of combined aspirin and high-dose IVIG-SN therapy in pediatric patients with Kawasaki disease (KD). Subjects and Methods: We evaluated coronary artery lesions (CALs) at 2 and 7 weeks after administering IVIG-SN; total fever duration; and variations in erythrocyte sedimentation rate, N-terminal pro B-type natriuretic peptide or B-type natriuretic peptide, and creatine kinase-myocardial band level before and after treatment with IVIG-SN (2 g/kg). Adverse events were monitored. Results: Forty-five patients were enrolled, three of whom were excluded according to the exclusion criteria; the other 42 completed the study. The male:female ratio was 0.91:1, and the mean age was 29.11±17.23 months. The mean fever duration before IVIG-SN treatment was 6.45±1.30 days. Although most patients had complete KD (40 patients, 90.91%), four had atypical KD (9.09%). After IVIG-SN treatment, one patient (2.38%) had CALs, which was significantly lower than the incidence reported previously (15%) (p=0.022), but not significantly different from recent data (5%). There were no serious adverse events, though 28 patients (63.64%) had mild adverse events. Three adverse drug reactions occurred in 2 patients (eczema, anemia, and increased eosinophil count), all of which were transient. Conclusion: IVIG-SN treatment in patients with KD was safe and effective.
윤경림 대한의사협회 2020 대한의사협회지 Vol.63 No.7
Chest pain is a very common symptom in pediatric patients. Although children with chest pain are relatively unlikely to be suffering from significant cardiac diseases, it is important not to overlook life-threatening diseases. Complete history taking and physical examination––which involves identifying the duration of pain, onset, character, associated symptoms, and aggravating factors––are extremely important. The most common causes of pediatric chest pain are idiopathic and musculoskeletal, while less than 3% of cases are of cardiac origin. Recent studies indicate that chest pain resulted from psychosomatic disorders increases in non-cardiac chest pain in children and adolescents. The reassurance of the benign nature of chest pain is enough in most cases of non-cardiac chest pain in children and adolescents. When echocardiography is performed on patients with exertional chest pain, it is important to confirm the origin of coronary artery to exclude any coronary anomaly. Exertional chest pain, combined syncope, and symptoms of myocardial ischemia should raise the suspicion of significant cardiac diseases. When the chest pain is accompanied by red flag signs, physicians must refer the patients to a pediatric cardiologist.
Update of genetic susceptibility in patients with Kawasaki disease
윤경림 대한소아청소년과학회 2015 Clinical and Experimental Pediatrics (CEP) Vol.58 No.3
Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects children, and canresult in coronary artery lesions (CAL). A patient with KD who is resistant to treatment with intravenousimmunoglobulin (IVIG) has a higher risk of developing CAL. Incomplete KD has increased in prevalencein recent years, and is another risk factor for the development of CAL. Although the pathogenesis of KDremains unclear, there has been increasing evidence for the role of genetic susceptibility to the diseasesince it was discovered in 1967. We retrospectively reviewed previous genetic research for knownsusceptibility genes in the pathogenesis of KD, IVIG resistance, and the development of CAL. Thisreview revealed numerous potential susceptibility genes including genetic polymorphisms of ITPKC,CASP3, the transforming growth factor-β signaling pathway, B lymphoid tyrosine kinase, FCGR2A,KCNN2, and other genes, an imbalance of Th17/Treg, and a range of suggested future treatmentoptions. The results of genetic research may improve our understanding of the pathogenesis of KD, andaid in the discovery of new treatment modalities for high-risk patients with KD.
윤경림 대한의사협회 2010 대한의사협회지 Vol.53 No.5
Chest pain is a very common symptom in children and adolescents. Musculoskeletal pain is the most common cause of their chest pain and the cardiac cause is very rare in children and adolescents. However, evaluation is required for every patient with chest pain, especially for those with the history and physical examination of importance. For common chest pains,reassurance and education of the patient and the parents about their benign nature is sufficient. On the other hand, chest pain on exertion, symptoms of myocardial ischemia, or abnormal cardiac examinations are more likely to be of cardiac origin, and prompt referral to a pediatric cardiologist is recommended.