March Christine A, Sastry Shruti, McPhaul Michael J, Wheeler Sarah E, Garibaldi Luigi
Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Horm Res Paediatr. 2025;98(3):316-326. doi: 10.1159/000539208. Epub 2024 May 3.
Stimulated copeptin may provide an alternative to water deprivation testing (WDT) in the evaluation of polyuria-polydipsia syndrome (PPS). Though best studied, arginine stimulation alone produces a modest copeptin response in children. We investigated the effectiveness of the arginine + LevoDopa/Carbidopa stimulation test (ALD-ST) for copeptin.
47 healthy short children (controls), 10 children with primary polydipsia, and 10 children with AVP deficiency received arginine hydrochloride (500 mg/kg intravenously over 30 min) and Levodopa/carbidopa (10:1 ratio; 175 mg of
In controls, ALD-ST increased copeptin from a median of 7.0 pmol/L (IQR 5.0-10.0) to a peak of 44.0 pmol/L (IQR 21.4-181.0) between 60 and 120 min (p < 0.001). Copeptin peak was higher in subjects who experienced nausea or vomiting (57%) than in those who did not (131.0 pmol/L [IQR 42.5-193.8] vs. 22.7 pmol/L [IQR 16.0-33.7], p < 0.001). While subjects with primary polydipsia had similar baseline (8.5 pmol/L [IQR 8.0-11.0]) and stimulated (125.2 pmol/L [IQR 87.6-174.0]) copeptin levels as controls, subjects with AVP deficiency had lower baseline (2.5 pmol/L [IQR 2.0-3.1]) and peak levels (4.6 pmol/L [IQR 2.4-6.0]). A peak copeptin of ≥9.3 pmol/L best predicted absence of complete or partial AVP deficiency with a sensitivity of 100% and specificity of 80%.
ALD-ST induced a robust peak copeptin in healthy short children and children with primary polydipsia. Nausea/vomiting, a side effect of ALD-ST, amplified the copeptin response. The ALD-ST may be a suitable initial screening test in children with PPS.
在多尿-多饮综合征（PPS）的评估中，刺激后测定 copeptin 可能是禁水试验（WDT）的一种替代方法。虽然研究最多的是单独使用精氨酸刺激，但在儿童中它只能引起适度的 copeptin 反应。我们研究了精氨酸+左旋多巴/卡比多巴刺激试验（ALD-ST）对 copeptin 的有效性。
47 名健康矮小儿童（对照组）、10 名原发性烦渴儿童和 10 名抗利尿激素（AVP）缺乏儿童接受了静脉注射盐酸精氨酸（30 分钟内 500mg/kg）和口服左旋多巴/卡比多巴（10:1 比例；175mg 左旋多巴/m²体表面积）。在 0、60、90 和 120 分钟时测量血清 copeptin。
在对照组中，ALD-ST 使 copeptin 水平从中位数 7.0pmol/L（四分位间距 5.0 - 10.0）在 60 至 120 分钟之间升至峰值 44.0pmol/L（四分位间距 21.4 - 181.0）（p < 0.001）。经历恶心或呕吐的受试者（57%）的 copeptin 峰值高于未经历者（131.0pmol/L[四分位间距 42.5 - 193.8]对 22.7pmol/L[四分位间距 16.0 - 33.7]，p < 0.001）。原发性烦渴受试者的基线（8.5pmol/L[四分位间距 8.0 - 11.0]）和刺激后（125.2pmol/L[四分位间距 87.6 - 174.0]）copeptin 水平与对照组相似，而 AVP 缺乏受试者的基线（2.5pmol/L[四分位间距 2.0 - 3.1]）和峰值水平（4.6pmol/L[四分位间距 2.4 - 6.0]）较低。copeptin 峰值≥9.3pmol/L 最能预测无完全或部分 AVP 缺乏，敏感性为 100%，特异性为 80%。
ALD-ST 在健康矮小儿童和原发性烦渴儿童中诱导出强烈的 copeptin 峰值。恶心/呕吐作为 ALD-ST 的副作用，增强了 copeptin 反应。ALD-ST 可能是 PPS 患儿合适的初始筛查试验。
