Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
Department of Clinical Research, University of Basel, Basel, Switzerland.
Eur J Endocrinol. 2023 Mar 2;188(3). doi: 10.1093/ejendo/lvad022.
One of the main medical treatment options for monosymptomatic nocturnal enuresis (MNE) is the vasopressin analog desmopressin. But not all children respond to desmopressin treatment, and no reliable treatment predictor has yet been established. We hypothesize that plasma copeptin, a surrogate marker for vasopressin, can be used to predict treatment response to desmopressin in children with MNE.
DESIGN/METHODS: In this prospective observational study, we included 28 children with MNE. At baseline, we assessed the number of wet nights, morning, and evening plasma copeptin, and plasma sodium and started treatment with desmopressin (120 µg daily). Desmopressin was increased to 240 µg daily if clinically necessary. The primary endpoint was reduction in the number of wet nights following 12 weeks of treatment with desmopressin using plasma copeptin ratio (evening/morning copeptin) at baseline.
Eighteen children responded to desmopressin treatment at 12 weeks, while 9 did not. A copeptin ratio cutoff of 1.34 (sensitivity 55.56%, specificity 94.12%, area under the curve 70.6%, P = .07) was best at predicting treatment response, with a lower ratio indicating a better treatment response. In contrast, neither the number of wet nights at baseline (P = .15) nor serum sodium (P = .11) alone or in combination with plasma copeptin improved outcome prediction.
Our results indicate that, of our investigated parameters, plasma copeptin ratio is the best predictor for treatment response in children with MNE. Plasma copeptin ratio could thus be useful to identify children with the highest benefit of desmopressin treatment and improve individualized treatment of MNE.
治疗单症状性夜间遗尿症（MNE）的主要医学治疗方法之一是使用抗利尿激素类似物去氨加压素。但并非所有儿童对去氨加压素治疗有反应，也尚未建立可靠的治疗预测指标。我们假设，血浆 copeptin（一种抗利尿激素的替代标志物）可用于预测 MNE 儿童对去氨加压素治疗的反应。
设计/方法：在这项前瞻性观察研究中，我们纳入了 28 名 MNE 儿童。在基线时，我们评估了夜间、早晨和傍晚血浆 copeptin 的数量以及血浆钠，并开始用去氨加压素（每日 120μg）进行治疗。如果临床上有必要，将去氨加压素增加至 240μg 每日。主要终点是使用基线时的血浆 copeptin 比值（傍晚/早晨 copeptin）评估去氨加压素治疗 12 周后夜间遗尿次数的减少。
18 名儿童在 12 周时对去氨加压素治疗有反应，而 9 名儿童无反应。Copeptin 比值为 1.34（敏感性 55.56%，特异性 94.12%，曲线下面积 70.6%，P=0.07）时预测治疗反应的效果最佳，比值越低表明治疗反应越好。相比之下，基线时夜间遗尿次数（P=0.15）或血清钠（P=0.11）单独或与血浆 copeptin 联合使用均不能改善预后预测。
我们的结果表明，在所研究的参数中，血浆 copeptin 比值是预测 MNE 儿童治疗反应的最佳指标。因此，血浆 copeptin 比值可用于识别去氨加压素治疗获益最高的儿童，并改善 MNE 的个体化治疗。
