Handa Tomoko, Hagiwara Daisuke, Maeda Ryutaro, Miyata Takashi, Kobayashi Tomoko, Sugiyama Mariko, Onoue Takeshi, Iwama Shintaro, Suga Hidetaka, Banno Ryoichi, Kuwatsuka Yachiyo, Arima Hiroshi
Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Clin Endocrinol Metab. 2025 Jul 30. doi: 10.1210/clinem/dgaf432.
In clinical practice, plasma arginine vasopressin (AVP) concentrations have been measured with a radioimmunoassay (RIA). However, RIAs have limitations, such as long turnaround time, use of radioisotopes, and restricted antibody availability. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) offers a promising alternative, eliminating the need for radioisotopes and antibodies while providing faster results.
This study aimed to assess the usefulness of LC-MS/MS for measuring plasma AVP concentrations in diagnosing AVP deficiency (AVP-D).
We included 16 patients with AVP-D and 28 controls. All participants underwent a hypertonic saline infusion test (HST), during which plasma AVP concentrations were measured using RIA and LC-MS/MS. Regression coefficients (gradients) for serum sodium versus plasma AVP concentrations were evaluated at 90 and 120 min, and receiver-operating characteristic (ROC) analyses were performed based on these regression coefficients.
The area under the ROC curve at 90 min was 0.97 (95% CI: 0.83-1.00) and 0.93 (95% CI: 0.80-0.98) for LC-MS/MS and RIA, respectively. A regression gradient cut-off with optimal values distinguished AVP-D from controls with a sensitivity of 100% in LC-MS/MS and RIA, whereas the specificity was 96% and 81% with LC-MS/MS and RIA, respectively. Sensitivity or specificity did not differ in 120 min between the two methods.
LC-MS/MS demonstrated superior diagnostic accuracy for AVP-D at 90 min of HST, indicating that the HST time can be shortened from 120 to 90 min by measuring AVP with LC-MS/MS.
在临床实践中，血浆精氨酸加压素（AVP）浓度通过放射免疫分析法（RIA）进行测量。然而，放射免疫分析法存在局限性，如周转时间长、使用放射性同位素以及抗体可用性受限。液相色谱 - 串联质谱法（LC-MS/MS）提供了一种有前景的替代方法，无需使用放射性同位素和抗体，同时能更快地得出结果。
本研究旨在评估LC-MS/MS在诊断AVP缺乏症（AVP-D）时测量血浆AVP浓度的实用性。
我们纳入了16例AVP-D患者和28名对照者。所有参与者均接受高渗盐水输注试验（HST），在此期间使用RIA和LC-MS/MS测量血浆AVP浓度。在90分钟和120分钟时评估血清钠与血浆AVP浓度的回归系数（斜率），并基于这些回归系数进行受试者操作特征（ROC）分析。
90分钟时，LC-MS/MS和RIA的ROC曲线下面积分别为0.97（95%CI：0.83 - 1.00）和0.93（95%CI：0.80 - 0.98）。具有最佳值的回归斜率截断值可将AVP-D与对照者区分开来，LC-MS/MS和RIA的灵敏度均为100%，而LC-MS/MS和RIA的特异性分别为96%和81%。两种方法在120分钟时的灵敏度或特异性无差异。
在高渗盐水输注试验90分钟时，LC-MS/MS对AVP-D的诊断准确性更高，这表明通过使用LC-MS/MS测量AVP，高渗盐水输注试验时间可从120分钟缩短至90分钟。
