EXPERIMENTAL AND THERAPEUTIC MEDICINE 22: 912, 2021 Efficacy of small‑dose ganciclovir on cytomegalovirus infections in children and its effects on liver function and miR‑UL112‑3p expression QINGXIU WANG1*, WENZENG ZHOU2*, BIN WANG3, GUOYUN QIN4, FENG'AI LIU5, DEXIANG LIU6 and TENGTENG HAN2 1Office of Hospital Infection Management, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031; 2Department of Child Rehabilitation, Zaozhuang Maternal and Child Health Hospital of Shandong Province, Zaozhuang, Shandong 277100; 3Department of Child Rehabilitation, The Second People's Hospital of Liaocheng, Liaocheng, Shandong 252600; 4Department of Pharmacy, Yidu Central Hospital, Weifang, Shandong 262500; 5Department of Paediatrics, Haiyang People's Hospital of Shandong Province, Haiyang, Shandong 265100; 6Department of Pediatrics, Laoling People's Hospital, Laoling, Shandong 253600, P.R. China Received April 3, 2020; Accepted February 1, 2021 DOI: 10.3892/etm.2021.10344 Abstract. The aim of the study was to explore the efficacy treatment, there was also no significant difference between the of small‑dose ganciclovir on cytomegalovirus infections as two groups in miR‑UL112‑3p, TB, ALT, and AST, while after well as its effects on the liver function and miR‑UL112‑3p treatment, both groups showed lower levels of miR‑UL112‑3p, of children. A total of 141 children infected with cyto‑ TB, ALT, and AST, and the Obs group showed significantly megalovirus admitted to the Affiliated Hospital of Weifang lower levels thereof than the Con group (all P<0.05). In addi‑ Medical University from May 2015 to August 2017 were tion, the area under the curve (AUC), specificity, and sensitivity enrolled, of which 74 children were treated with small‑dose of miR‑UL112‑3p in the ROC curve of the Obs group were ganciclovir as an observation group (Obs group), and the rest 0.866, 73.77 and 84.62%, respectively, while the AUC, speci‑ were treated with conventional‑dose ganciclovir as a control ficity, and sensitivity of the ROC of the Con group were 0.837, group (Con group). The two groups were compared in effi‑ 75.44, and 90.00%, respectively. Furthermore, miR‑UL112‑3p cacy after treatment, changes of liver function indexes [total was positively correlated with TB, ALT, and AST, respec‑ bilirubin (TB), alanine aminotransferase (ALT), and aspartate tively. The CMV‑DNA level in the Obs group was lower than aminotransferase (AST)] and miR‑UL112‑3p before and after that in the Con group, but the difference was not significant, treatment, and adverse reactions after treatment. A receiver and the level of CMV‑DNA was positively correlated with operating characteristic (ROC) curve was drawn to analyze that of miR‑UL112‑3p. In conclusion, small‑dose ganciclovir the value of miR‑UL112‑3p in predicating efficacy on cyto‑ can better improve the liver function of the children, and megalovirus infections in children, and Pearson's correlation downregulate miR‑UL112‑3p in them. The AUC, specificity, analysis was carried out to analyze the correlation between and sensitivity of miR‑UL112‑3p for predicting the efficacy of miR‑UL112‑3p expression and TB, ALT and AST. The small‑dose ganciclovir were 0.866, 73.77 and 84.62%, respec‑ MV‑DNA level between the two groups after treatment was tively, and the AUC, specificity, and sensitivityfor predicting compared. The two groups showed no significant difference the efficacy of conventional‑dose ganciclovir were 0.837, in efficacy and adverse reactions (both P>0.05), and before 75.44 and 90.00%, respectively. Introduction Human cytomegalovirus is a herpesvirus, which is widespread Correspondence to: Dr Tengteng Han, Department of Child in people, and most infected individuals exhibit no specific Rehabilitation, Zaozhuang Maternal and Child Health Hospital of clinical characteristics. According to statistics, the infection rate Shandong Province, 25 Wenhua East Road, Shizhong, Zaozhuang, of this virus in adults in the West is between 60 and 70% (1). Shandong 277100, P.R. China E‑mail: [email protected] However, children are the main vulnerable group of the virus. The body function of children is not fully developed and their *Contributed equally immune function is weaker than that of normal adults, suggesting that more attention should be paid to children infected with Key words: ganciclovir, small dose, cytomegalovirus infections in cytomegalovirus with regard to diagnosis and treatment (2). children, liver function, miR‑UL112‑3p Cytomegalovirus often leads to pathological changes in the lung and liver of children, and its infection is one of the primary risk factors for hearing damage in children, which can lead to 2 WANG et al: EFFECT OF GANCICLOVIR ON CYTOMEGALOVIRUS INFECTIONS IN CHILDREN dysplasia of brain and neuron, and even death (3‑5). Therefore, used in this study, iv) patients with detailed clinical data, and it is imperative to evaluate the severity of illness and efficacy on v) patients willing to receive the therapy and follow‑up. children and to implement effective treatments. The exclusion criteria included: i) Patients who had MicroRNA is a non‑coding single‑stranded small RNA received antiviral treatment within one month before admis‑ molecule in human body, which affects the development and sion, ii) patients with other comorbid liver or kidney diseases, progression of some diseases and can be used as a potential or other viral infectious diseases, and iii) patients with indicator of various diseases (6‑8). Previous findings have congenital immune diseases. shown that there are some exogenous microRNAs stemming from viruses and microorganisms in the human body that Main kits and instruments. PCR instrument (Applied participate in the development and progression of some Biosystems 7500), electrophoresis apparatus (Bio‑Rad diseases (9). miR‑UL112‑3p is a microRNA encoded by human Mini‑PROTEAN), ultraviolet spectrophotometer cytomegalovirus, which is involved in viral transcriptional (Beckman Coulter, DU 700), fully automatic biochemical activation and immune evasion, and is related to the regula‑ analyser (Abbott Aeroset 2000), total RNA extraction kit tion of cell cycle, proliferation and apoptosis (10). One study (EasyPure miRNA Kit) and reverse transcription + PCR kit by Pan et al (11) has found another microRNA encoded by (TransScript miRNA First‑Strand cDNA Synthesis SuperMix; cytomegalovirus that may be used as a therapeutic indicator TransGen Biotech Co., Ltd.; nos. ER601‑01, AT351‑01). for hepatitis B. Therefore, we suspected that miR‑UL112‑3p Primers were designed and synthesized by Shanghai Sangon can also be used to evaluate the efficacy on children. Biotech Co., Ltd. (Table I). Ganciclovir is a common antiviral drug in clinical practice, with relatively good efficacy on cytomegalovirus infection Treatment methods. Children in the Obs group were treated in children (12). However, there are some side effects in the with small‑dose ganciclovir as follows: They were given ganci‑ treatment process, causing symptoms such as myelosup‑ clovir mixed with 5% glucose solution through intravenous pression (13). The liver function of children infected with drip at 3 mg/kg (12 h/time) for a course of 6 weeks. By contrast, cytomegalovirus is often damaged. However, findings of recent children in the Con group were treated with conventional‑dose studies have shown that ganciclovir can improve the liver func‑ ganciclovir as follows: They were given ganciclovir mixed tion of patients with hepatitis C virus (HCV) liver fibrosis, and with 5% glucose solution through intravenous drip at 5 mg/kg can alleviate hepatitis Caused by cytomegalovirus infections (12 h/time) for a course of 6 weeks (16). in children (14,15). However, few studies are available on the effect of small‑dose ganciclovir on the liver function of Basis for efficacy evaluation. The efficacy on the two groups children infected with cytomegalovirus, the specific efficacy was analyzed, and the number of patients with markedly effec‑ and safety thereof. and its effects on miR‑UL112‑3p. tive treatment, effective treatment or ineffective treatment was Therefore, the aim of the current study was to examine counted, separately. Treatment with the following outcomes the efficacy of small‑dose ganciclovir and conventional‑dose was determined as markedly effective: Disappearance of ganciclovir on children infected with cytomegalovirus, and clinical symptoms and signs, and retraction of liver and spleen analyze the changes of the liver function and miR‑UL112‑3p to normal. Treatment with the following outcomes was deter‑ expression in children before and after treatment, to provide a mined as effective: Relief of clinical symptoms and signs, and basis and direction for the clinical application of ganciclovir. significant retraction of liver and spleen. Treatment with the following outcomes was determined as ineffective: No signifi‑ Materials and methods cant relief of the disease or aggravation for the patient (17). The total number of cases with effective treatment were Patients. A total of 141 children infected with cytomegalo‑ calculated as: The number of cases with markedly effective virus admitted to the Affiliated Hospital of Weifang Medical treatment + the number of cases with effective treatment. University from May 2015 to August 2017 were enrolled, of which 74 children were treated with small‑dose ganciclovir Determination methods. Venous blood (5 ml) was sampled from as an observation group (Obs group), and the rest were each child, and placed