الفهرس 
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Abstract
Background: Rheumatic heart disease (RHD) and Kawasaki disease (KD) are the most common acquired heart diseases in children. The pathogenesis of both diseases is not completely understood but abnormal immune response plays a vital role. The regulatory T cell (Tregs) is essential for prevention of autoimmunity. Immunomodulation therapy could serve as a possible alternative treatment strategy for the autoimmune diseases.The aim of the work: to assess the level of circulating regulatory T cells in children of RHD and KD & their relation to disease severity, treatment resistance and disease recurrence.Materials and Methods: Patients and Methods: 60 children were subdivided into 3 groups: RHD, KD, and control, 20 children for each. The patients were on regular follow up at the pediatric cardiology outpatient clinic of Mansoura University Children Hospital from January 2018 to January 2019. Blood was obtained from patients and controls for estimation regulatory T cells by flow cytometry.Results: On analysis we found that the level of Tregs (CD4+CD25med–highCD127low) in CD4+ T lymphocyte was significantly lower in RHD patients & KD patients compared to controls (6.38±1.36 & 6.92±1.83 vs 9.36±1.48; p<0.001). Tregs in RHD patients were significantly lower in multivavular group than univalvular group (4.47±0.06 vs 6.72±1.2; p=0.004), were significantly lower in patients with recurrence than patients without (4.45±0.07 vs 6.59±1.25; P=0.03).Tregs in KD patients were lower in IVIG resistant cases than IVIG senstive cases (6.80±0.57 vs 6.91±1.7; p=0.1).Conclusion: There is significant deficiency of circulating Tregs in patients of RHD and it is correlated with severity and recurrence of the disease.There is significant deficiency of circulating Tregs in patients of KD and it may predict resistance to IVIG therapy to consider appropriate treatment strategies. Therapy to directly induce Tregs could serve as a possible alternative treatment for RHD and KD.