Sepesy Lisa M, Center Sharon A, Randolph John F, Warner Karen L, Erb Hollis N
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
J Am Vet Med Assoc. 2006 Jul 15;229(2):246-52. doi: 10.2460/javma.229.2.246.
To determine disorders associated with vacuolar hepatopathy (VH), morphologic hepatic and clinicopathologic abnormalities, and affiliation with steroidogenic hormone excess in dogs.
Retrospective case series. Animals-336 dogs with histologically confirmed moderate or severe VH.
Information on signalment, results of diagnostic testing, definitive diagnoses, and exposure to glucocorticoids (ie, exogenous glucocorticoid administration or high endogenous concentrations of steroidogenic hormones) was obtained from medical records. Dogs were grouped by underlying disorder, glucocorticoid exposure, acinar zonal distribution of lesions, and histologic severity.
12 disease groups (neoplastic, acquired hepatobiliary, neurologic, immune-mediated, gastrointestinal tract, renal, infectious, cardiac disease, diabetes mellitus, portosystemic vascular anomaly, adrenal gland dysfunction, and miscellaneous disorders) were identified. There were 186 (55%) dogs with and 150 (45%) dogs without evidence of glucocorticoid exposure. Acinar zonal distribution of hepatic vacuolation and clinicopathologic values did not differ between dogs with and without evidence of glucocorticoid exposure. However, a 3-fold increased likelihood of severe VH was associated with steroidogenic hormone exposure. Of 226 dogs with high serum alkaline phosphatase activity, 102 (45%) had no evidence of glucocorticoid exposure.
Results suggest that neoplasia and congenital or acquired hepatobiliary disease are common in dogs with VH and provide support for the suggestion that VH, high alkaline phosphatase activity, and illness-invoked physiologic stress may be associated. Histologic confirmation of VH should initiate a diagnostic search for a primary disease if glucocorticoid treatment and hyperadrenocorticism are ruled out.
确定与犬空泡性肝病(VH)相关的疾病、肝脏形态学和临床病理异常,以及与类固醇生成激素过多的关联。
回顾性病例系列研究。动物——336只经组织学证实患有中度或重度VH的犬。
从病历中获取有关动物特征、诊断测试结果、确诊诊断以及糖皮质激素暴露情况(即外源性糖皮质激素给药或内源性类固醇生成激素浓度过高)的信息。根据潜在疾病、糖皮质激素暴露情况、病变的腺泡区分布和组织学严重程度对犬进行分组。
确定了12个疾病组(肿瘤性、获得性肝胆疾病、神经系统疾病、免疫介导性疾病、胃肠道疾病、肾脏疾病、感染性疾病、心脏病、糖尿病、门体循环血管异常、肾上腺功能障碍和其他杂症)。有186只(55%)犬有糖皮质激素暴露证据,150只(45%)犬无糖皮质激素暴露证据。有和无糖皮质激素暴露证据的犬之间,肝空泡化的腺泡区分布和临床病理值没有差异。然而,类固醇生成激素暴露与严重VH的可能性增加3倍相关。在226只血清碱性磷酸酶活性高的犬中,102只(45%)无糖皮质激素暴露证据。
结果表明,肿瘤和先天性或获得性肝胆疾病在患有VH的犬中很常见,并支持VH、高碱性磷酸酶活性和疾病引发的生理应激可能相关的观点。如果排除糖皮质激素治疗和肾上腺皮质功能亢进,VH的组织学确诊应启动对原发性疾病的诊断性检查。