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Original Article Effects of Ulinastatin Injection Combined with Antibiotic Therapy in Children with Severe Pneumonia Via Levels of Serums Sb7-H3, CCL18 and GM-CSF

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Original Article Effects of Ulinastatin Injection Combined with Antibiotic Therapy in Children with Severe Pneumonia Via Levels of Serums Sb7-H3, CCL18 and GM-CSF Int J Clin Exp Med 2020;13(10):8150-8157 www.ijcem.com /ISSN:1940-5901/IJCEM0115147 Original Article Effects of ulinastatin injection combined with antibiotic therapy in children with severe pneumonia via levels of serums sB7-H3, CCL18 and GM-CSF Qi Tian1, Yan Wang1, Chao Huang1, Ting Han2 1Department of Pediatrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang 277100, Shandong, China; 2Department of Pediatric Intensive Care Unit, Maternity and Child Health Care of Zaozhuang, Zaozhuang 277100, Shandong, China Received May 27, 2020; Accepted August 12, 2020; Epub October 15, 2020; Published October 30, 2020 Abstract: Objective: To probe and analyze the effects of ulinastatin injection combined with antibiotic escala- tion therapy in children with severe pneumonia by measuring the levels of serums sB7-H3, CCL18 and GM-CSF. Methods: A total of 106 children with severe pneumonia admitted to our hospital were randomized into the obser- vation group (n=55) and the control group (n=51) based on a random number table. The control group was treated with antibiotic ladder-like therapy, while the observation group was treated with ulinastatin injection in addition to the antibiotic ladder-like therapy. We compared the therapeutic effects and the changes of serum inflammatory fac- tors, sB7-H3, CCL18 and GM-CSF between the two groups. Results: The observation group showed higher overall effective rates than the control group (P<0.05). Both the time of antibiotics usage and the length of hospitalization of the children in the observation group were significantly shorter than the control group (P<0.05). After treatment, the levels of serum inflammatory factors of the children in the observation group were significantly lower than those of the control group (P<0.05). The levels of serum sB7-H3, CCL18 and GM-CSF in the children in the observation group were significantly lower than the control group (P<0.05). Conclusion: Treating severe pneumonia in children with ulinastatin injection combined with antibiotic ladder-like therapy can effectively improve the clinical efficacy of treatment, and its mechanism of action may be related to inhibiting the inflammatory response and regulating the immune balance in the human body. The therapy is highly safe and worthy of clinical application. Keywords: Ulinastatin injection, antibiotic ladder-like therapy, children with severe pneumonia, sB7-H3, CCL18, GM-CSF Introduction matory response syndrome, so the treatment principles for severe pneumonia from the WHO Pneumonia is a common and frequently occur- include early hospitalization and early use of ring disease in children, and it is also the lead- intravenous antibiotics [2]. However, the wide- ing cause of death in children. The previous spread use of antibiotics, especially spectral definition of severe pneumonia was limited to antibiotics, can often lead to the dysbacteriosis whether children with pneumonia had symp- of children and the resistance of pathogenic toms and signs involving other systemic bacteria, which makes a routine infectious dis- responses. Currently it is considered that chil- eases gradually evolve into severe pneumonia. dren can be diagnosed with severe pneumonia If the children are not treated promptly and as long as they have systemic inflammatory effectively, it can induce the failure of multiple reactions and severe ventilation dysfunction organs and can lead to their death, which there- [1]. The diagnosis of children with severe pneu- fore poses a serious threat to the health and monia covers their clinical symptoms, chest life safety of these patients [3].Proposed in the radiograph changes, etiological examination, early 21st century, the idea of de-escalation and arterial blood gas analysis. Children with treatment is to adopt the most appropriate severe pneumonia are prone to systemic inflam- broad-spectrum antibiotics in the initial stage Ulinastatin injection in the treatment of severe pneumonia of the disease to effectively cover the patho- Exclusion criteria: (1) The children were compli- genic bacteria that may cause infection, such cated with diseases in other vital organs, such as Gram-positive bacteria and Gram-negative as heart, liver, and/or kidney; (2) The children bacteria, so that the infection can be controlled; were complicated with congenital heart dis- thereby adjusting the type of medicine and dos- ease and/or immune dysfunction disease; (3) age according to the test results and the chang- The children had a history of complicated es in the children’s clinical symptoms after 2-3 chronic bronchial asthma of the respiratory days of medicine, and implement correspond- tract. ing targeted treatment. De-escalation antibiot- ic therapy has now become an important guid- Methods ing program for the treatment of severe pneu- monia in children [4]. Ulinastatin injection is a The children it the control group were treated kind of spectral protease inhibitor extracted with antibiotic de-escalation therapy. They from human urine, which has a variety of bio- received a continuous intravenous drip of logical functions such as stabilizing lysosomal Meropenem injection with a drug dose of enzyme membranes, anti-inflammatory, antico- 10~20 mg/kg every 8 hours. The patients then agulation and anti-oxidation effects [5]. In order were given an intravenous infusion once every to further enhance the clinical efficacy of treat- 12 hours after their condition was relieved. The ment for children with severe pneumonia, this sputum of the children before antibiotic treat- study probed and analyzed the effects of ulina- ment was inoculated in a blood plate, EMB statin injection combined with antibiotics de- plate or chocolate agar plate to isolate and cul- escalation therapy on children with severe ture the pathogenic bacteria. We then obtained pneumonia by measuring the levels of serum the pathogenic examination result within 72 sB7-H3, CCL18 and GM-CSF. The report is as hours, developed the corresponding antibiotic follows. de-escalation therapy program in accordance with the pathogenic culture results, and cus- Materials and methods tomized the corresponding high-sensitivity, narrow-spectrum, low-toxic and low-cost antibi- Clinical data otics for treatment. A total of 106 children with severe pneumonia The children in the observation group were admitted to our hospital between March 2018 treated with intravenous drip of Ulinastatin and March 2019 were selected as the research (UTI) injection in addition to the antibiotic subjects, including 64 males and 42 females. de-escalation therapy of the control group The children were aged 2 to 14 years, with an (Guangdong Techpool Biochemical Medicine average age of 6.28 (±2.10) years. Among Co. LTD., G.Y.Z.Z. H20040506). Treatment con- them, there were 23 children with left lung dis- sisted of 200,000 U UTI and 50 ml 0.9% NaCl ease, 27 with right lung disease and 56 with injection for a micro-pump injection, twice per double lung disease. All the children were ran- day, and 7 days was set as one course of domized into either the observation group treatment, and 2 consecutive courses were (n=55) or the control group (n=51) based on a performed. random number table. The study was approved by the Ethics Committee of our hospital. Evaluation criteria of clinical efficacy Inclusion and exclusion criteria Referring to the literature criteria [7], COMPLETE RESPONSE: The clinical symptoms and signs, Inclusion criteria: (1) The children conformed to such as consciousness disorders, fever and the diagnostic criteria for severe pneumonia [6] shortness of breath of the children, were com- and were accompanied by disturbance of con- pletely improved or significantly reduced, and sciousness, with arterial systolic blood pres- the pathological indicators of etiology and sure <90 mmHg and respiratory rate up to 30/ laboratory examination returned to normal, min; some were complicated with septic shock MARKED RESPONSE: The clinical symptoms and were confirmed by X-ray; (2) The children and signs of the children were significantly were aged 2 to 14 years old; (3) The parents of improved, but the laboratory examination and the children voluntarily signed the informed etiological examination indexes did not com- consent. pletely returned to normal. RESPONSE: The 8151 Int J Clin Exp Med 2020;13(10):8150-8157 Ulinastatin injection in the treatment of severe pneumonia Table 1. Comparison of clinical data between the two groups of children Number Gender Lesion site Group Age (Age, ±s) of cases Male Female Left lung Right lung Two lungs The observation group 55 34 21 6.13±1.97 13 11 31 The control group 51 30 21 6.34±2.35 10 16 25 t/X2 - 0.099 0.500 -0.376 P - 0.753 0.618 0.707 Table 2. Comparison of clinical efficacy between the two groups of children [n (%)] Number Complete Marked Group Response No response Overall response rate (%) of cases response response The observation group 55 23 (41.82) 15 (27.27) 12 (21.82) 5 (9.09) 90.91 The control group 51 17 (33.33) 9 (17.65) 8 (15.69) 12 (23.53) 76.47 x2 - - - - - 4.097 P - - - - - 0.043 clinical symptoms and signs of the children Statistical analysis improved, and the laboratory examination indexes and etiological examination were The data was analyzed by statistical software improved to some extent. NO RESPONSE: SPSS 22.0; the measurement data conforming Children did not achieve any of the improve- to a normal distribution was expressed by (x ± ments stated above. Overall response rate = s), and t-test was used for comparison; the data Complete response rate + Marked response were expressed by percentage, and the com- rate + Response rate. parison was made by chi-squared test. P<0.05 suggested that the difference was statistically Observational indexes significant. (1) The usage time of antibiotics and the hospi- Results talization time between the two groups of chil- dren were compared.
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