Durham A E, Newton J R, Smith K C, Hillyer M H, Hillyer L L, Smith M R W, Marr C M
The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire GU30 7JG, UK.
Equine Vet J. 2003 Sep;35(6):542-7. doi: 10.2746/042516403775467324.
Results of noninvasive tests of liver disease do not always correlate with the degree of hepatic disease nor outcome of the case.
To investigate the prognostic value of data collected using noninvasive tests during the investigation of cases of suspected liver disease in mature horses.
Much of the data gathered during the investigation of suspected hepatopathy cases offers little prognostic guidance and interpretation of such data can be misleading.
The results from a range of common and noninvasive diagnostic techniques applied in 116 mature horses with suspected liver disease, were assessed for their ability to predict survival within a 6 month period.
A significantly poorer prognosis was found in association with clinical signs suggestive of liver disease, presence of hepatic encephalopathy, ultrasonographic abnormalities, increased serum globulins, increased total bile acids (TBA), increased alkaline phosphatase (AP), increased gamma-glutamyl transferase (gammaGT), erythrocytosis, leucocytosis, low serum albumin and low serum urea. Additional significant novel findings of interest included an association between increased plasma fibrinogen and low serum creatinine concentrations with nonsurvival in cases of liver disease, an association between raised serum concentrations of AP and gammaGT with biliary hyperplasia and also an association between hepatic fibrosis, haemosiderosis and biliary hyperplasia with ultrasonographically detected hepatic abnormalities.
The most useful noninvasive prognostic test in cases of suspected liver disease in mature horses is the severity of clinical signs. Other data may be of some limited prognostic value.
Application of the findings in this study may not be directly applicable to other case populations. However, the findings should at least be considered when prognosis is based on similar criteria.
肝病的非侵入性检测结果并不总是与肝病的严重程度或病例的预后相关。
调查在对成年马疑似肝病病例进行检查期间,使用非侵入性检测收集的数据的预后价值。
在对疑似肝病病例进行检查期间收集的许多数据几乎没有预后指导作用,对这些数据的解读可能会产生误导。
对应用于116匹成年疑似肝病马的一系列常见非侵入性诊断技术的结果进行评估,以确定它们预测6个月内存活率的能力。
发现与提示肝病的临床体征、肝性脑病的存在、超声异常、血清球蛋白增加、总胆汁酸(TBA)增加、碱性磷酸酶(AP)增加、γ-谷氨酰转移酶(γGT)增加、红细胞增多、白细胞增多、血清白蛋白降低和血清尿素降低相关的预后明显较差。其他有趣的重要新发现包括,在肝病病例中,血浆纤维蛋白原增加和血清肌酐浓度降低与非存活相关;血清AP和γGT浓度升高与胆管增生相关;肝纤维化、血色素沉着症和胆管增生与超声检测到的肝脏异常相关。
在成年马疑似肝病病例中,最有用的非侵入性预后检测是临床体征的严重程度。其他数据可能具有一定的有限预后价值。
本研究结果的应用可能不适用于其他病例群体。然而,在基于类似标准进行预后判断时,至少应考虑这些发现。