Wang Hui, Lin Yao, Wang Yuting, Shen Chen, Li Yaqi, Liu Yang, Shi Lin
Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Pharmacol. 2024 Dec 13;15:1425863. doi: 10.3389/fphar.2024.1425863. eCollection 2024.
There is a lack of suitable predictive markers for assessing the efficacy of amlodipine in treating children with primary hypertension. This study aimed to explore whether plasma calcitonin gene-related peptide (CGRP) and nitric oxide (NO) could predict the effectiveness of amlodipine in pediatric primary hypertension.
This study enrolled 74 children and adolescents with primary hypertension who were prescribed amlodipine monotherapy, and after 4 weeks of treatment, they were divided into responders and non-responders according to blood pressure. Baseline data differences between the two groups were analyzed, followed by binary logistic regression to assess the correlation between significant variables and therapeutic efficacy. The receiver operating characteristic curve was used to evaluate the predictive efficacy, and the nomogram model was established to predict therapeutic response to amlodipine.
The responders exhibited lower body mass index, C-peptide and plasma CGRP levels, and higher NO levels compared to the non-responders ( < 0.05). Multivariable logistic analysis revealed that plasma CGRP and NO were independently associated with the therapeutic response to amlodipine, showing a higher predictive performance when used in combination (AUC: 0.814, 95% CI 0.714-0.914) with a predictive sensitivity of 86.5% and specificity of 70.1%. The nomogram model displayed good calibration, and the decision curve analysis indicated this model led to net benefits in a wide range of threshold probability.
CGRP and NO may be valuable biomarkers for predicting amlodipine effectiveness in the treatment of pediatric primary hypertension, while the nomogram model indicates excellent predictive value.
目前缺乏合适的预测指标来评估氨氯地平治疗儿童原发性高血压的疗效。本研究旨在探讨血浆降钙素基因相关肽（CGRP）和一氧化氮（NO）能否预测氨氯地平治疗儿童原发性高血压的疗效。
本研究纳入74例接受氨氯地平单药治疗的儿童和青少年原发性高血压患者，治疗4周后，根据血压将其分为反应者和无反应者。分析两组之间的基线数据差异，然后进行二元逻辑回归以评估显著变量与治疗效果之间的相关性。采用受试者工作特征曲线评估预测效能，并建立列线图模型以预测对氨氯地平的治疗反应。
与无反应者相比，反应者的体重指数、C肽和血浆CGRP水平较低，而NO水平较高（<0.05）。多变量逻辑分析显示，血浆CGRP和NO与氨氯地平的治疗反应独立相关，联合使用时显示出更高的预测性能（AUC：0.814，95%CI 0.714-0.914），预测敏感性为86.5%，特异性为70.1%。列线图模型显示出良好的校准，决策曲线分析表明该模型在广泛的阈值概率范围内带来净效益。
CGRP和NO可能是预测氨氯地平治疗儿童原发性高血压疗效的有价值生物标志物，而列线图模型显示出优异的预测价值。
