While many studies have shown that a neutrophil elastase inhibitor (Sivelestat) prevents the progression of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), the effect of Sivelestat in children with ALI/ARDS has been difficult to assess. Recently HMGB-1 has been proposed as one of the late mediators of sepsis or lipopolysaccharide endotoxin lethality, although it is unknown well what kind of role HMGB-1 plays in diseases. The aim of our study is to evaluate the effect of Sivelestat and to determine whether it can reduce the levels of HMGB-1 in children with ALI/ARDS.
Eight children with a diagnosis of ALI or ARDS in our pediatric intensive care unit had been parted randomly into two groups. Neutrophil elastase activity (NEA) and HMGB-1 were measured as inflammatory markers. PaO2/FiO2 (P/F) ratio, A-aDO2 and Lung Injury Score (LIS) were also measured as respiratory markers.
Among the 8 children enrolled in this study (total mean age was 6.5 ± 4.5 years,there is no significant difference between two groups), all cause of ALI/ARDS were direct lung injuries, 7 pneumonia cases and one being drowned with the pond.The group treated with Sivelestat had significantly short periods of hospitalization and respirator management in comparison with the control group. NEA as an acute inflammatory promoter was lower in the treated group at day1 which becomes peak. HMGB-1 increases in a time internal from several hours to days after the beginning of inflammation. Treated group had significantly lower value of HMGB-1 at day7.
Svelestat has clinically effective in children with ALI/ARDS. Increase of NEA seems to be suppressed in the treated group after the ALI/ARDS emerging. However, the detailed mechanism of our result that the group treated with Sivelestat had significantly lower value of HMGB-1 at day7 is remain unclear, we suggest that Sivelestat has a depressive effect at inflammation of subacute period.
There is clinical effect of Neutrophil elastase inhibitor which reduce HMGB-1 at subacute piriod in children with ALI/ARDS.
Yuki Okamatsu, No Financial Disclosure Information; No Product/Research Disclosure Information