Sastry Shruti, Tas Emir, Filingeri Domenic, McCann Erika, Amruthapuri Rahul, McPhaul Michael J, Garibaldi Luigi
Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.
J Pediatr Endocrinol Metab. 2024 Dec 18;38(2):110-115. doi: 10.1515/jpem-2024-0422. Print 2025 Feb 25.
Limited data are available on the hormonal response of children to venepuncture or intravenous cannulation (IVC). Catecholamines (epinephrine (E) and norepinephrine (NE)) have been traditionally recognized as stress hormones. Copeptin, the carboxyl-terminus of the arginine vasopressin (AVP) precursor peptide, is also a known marker for stressful stimuli, including myocardial infarction, critical illness, and sepsis. We aimed to measure the above stress markers in response to IVC in the pediatric population.
We measured plasma E, NE and serum copeptin concentrations in 100 children aged 5-17 years undergoing endocrine testing. Labs were drawn 1-3 min (min) after placement of IV cannula (baseline or 0 min) and then re-measured 20 min later (+20 min) while subjects rested in a quiet room.
Between 0 and 20 min, the median (IQR) NE (n=99) changed from 349 (244, 482) pg/mL to 253 (184, 348) pg/mL (p<0.001); E (n=54) changed from 57 (43, 116) pg/mL to 57 (38, 96) pg/mL (p=0.024); Copeptin changed from 9.4 (6.3, 15.2) pmol/L to 9 (5, 13) pmol/L (p<0.001). The mean decrease (delta) was 106 pg/mL for NE (28 %, p<0.001), 16 pg/mL for E (18 %, p=0.042) and 2.7 pmol/L for copeptin (17 %, p=0.012). There was no correlation between the decrease (expressed as a percentage) in NE vs. E, E vs. copeptin, and NE vs. copeptin.
Our data suggest that the stress of IVC induces a rapid increase in NE, E, as previously described, as well as copeptin levels. The copeptin decrement, concordant with the catecholamine trend in the minutes after IVC, supports this peptide (and AVP) as a rapid response marker of stress, and has unclear practical implications for copeptin measurements in evaluating fluid and sodium metabolism disorders in children.
关于儿童对静脉穿刺或静脉置管（IVC）的激素反应的数据有限。传统上，儿茶酚胺（肾上腺素（E）和去甲肾上腺素（NE））被认为是应激激素。copeptin是精氨酸加压素（AVP）前体肽的羧基末端，也是包括心肌梗死、危重病和脓毒症在内的应激刺激的已知标志物。我们旨在测量儿科人群对IVC反应时的上述应激标志物。
我们测量了100名年龄在5至17岁接受内分泌检查的儿童的血浆E、NE和血清copeptin浓度。在放置静脉套管后1 - 3分钟（基线或0分钟）采集血样，然后在受试者在安静房间休息20分钟后（+20分钟）再次测量。
在0至20分钟之间，NE（n = 99）的中位数（IQR）从349（244，482）pg/mL变为253（184，348）pg/mL（p < 0.001）；E（n = 54）从57（43，116）pg/mL变为57（38，96）pg/mL（p = 0.024）；copeptin从9.4（6.3，15.2）pmol/L变为9（5，13）pmol/L（p < 0.001）。NE的平均下降（差值）为106 pg/mL（28%，p < 0.001），E为16 pg/mL（18%，p = 0.042），copeptin为2.7 pmol/L（17%，p = 0.012）。NE与E、E与copeptin、NE与copeptin之间的下降（以百分比表示）无相关性。
我们的数据表明，IVC的应激如先前所述会导致NE、E以及copeptin水平迅速升高。copeptin的下降与IVC后几分钟内儿茶酚胺的趋势一致，支持该肽（和AVP）作为应激的快速反应标志物，并且对于评估儿童液体和钠代谢紊乱时copeptin测量的实际意义尚不清楚。
