甲状腺机能亢进猫治疗后的生存和氮血症的发展。
Survival and the development of azotemia after treatment of hyperthyroid cats.
机构信息
Department of Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, Hatfield, UK.
出版信息
J Vet Intern Med. 2010 Jul-Aug;24(4):863-9. doi: 10.1111/j.1939-1676.2010.0550.x.
BACKGROUND
Hyperthyroidism complicates the diagnosis of chronic kidney disease (CKD) as it increases glomerular filtration rate. No practical and reliable means for identifying those cats that will develop azotemia after treatment for hyperthyroidism has been identified. Hyperthyroidism is associated with proteinuria. Proteinuria has been correlated with decreased survival of cats with CKD and with progression of CKD.
HYPOTHESIS
Proteinuria and other clinical parameters measured at diagnosis of hyperthyroidism will be associated with the development of azotemia and survival time.
ANIMALS
Three hundred client owned hyperthyroid cats treated in first opinion practice.
METHODS
Retrospective, cohort study relating clinical parameters in hyperthyroid cats at diagnosis to the development of azotemia within 240 days of diagnosis and survival time (all cause mortality). Multivariable logistic regression analysis was used to identify factors that were predictive of the development of azotemia. Multivariable Cox regression analysis was used to identify factors associated with survival.
RESULTS
Three hundred cats were eligible for survival analysis and 216 cats for analysis of factors associated with the development of azotemia. The median survival time was 417 days, and 15.3% (41/268) cats developed azotemia within 240 days of diagnosis of hyperthyroidism. Plasma concentrations of urea and creatinine were positively correlated with the development of azotemia. Plasma globulin concentration was negatively correlated with the development of azotemia. Age, urine protein:creatinine ratio, and the presence of hypertension were significantly correlated with decreased survival time. Urine specific gravity and PCV were significantly correlated with increased survival time.
CONCLUSIONS AND CLINICAL IMPORTANCE
The proteinuria associated with hyperthyroidism is not a mediator of progression of CKD; however, it does correlate with all cause mortality.
背景
甲状腺功能亢进会增加肾小球滤过率，从而使慢性肾脏病（CKD）的诊断变得复杂。目前还没有一种实用且可靠的方法来确定那些在治疗甲状腺功能亢进后会出现氮血症的猫。甲状腺功能亢进与蛋白尿有关。蛋白尿与患有 CKD 的猫的生存率降低以及 CKD 的进展有关。
假设
甲状腺功能亢进症诊断时测量的蛋白尿和其他临床参数与氮血症的发展和生存时间有关。
动物
300 只在第一诊疗点接受治疗的患有甲状腺功能亢进的宠物猫。
方法
回顾性队列研究，将患有甲状腺功能亢进的猫在诊断时的临床参数与诊断后 240 天内氮血症的发展和生存时间（全因死亡率）相关联。使用多变量逻辑回归分析来确定预测氮血症发展的因素。使用多变量 Cox 回归分析来确定与生存相关的因素。
结果
300 只猫有资格进行生存分析，216 只猫进行了与氮血症发展相关因素的分析。中位生存时间为 417 天，268 例中有 15.3%（41/268）在诊断为甲状腺功能亢进后的 240 天内出现氮血症。血浆尿素和肌酐浓度与氮血症的发展呈正相关。血浆球蛋白浓度与氮血症的发展呈负相关。年龄、尿蛋白：肌酐比值和高血压的存在与生存时间缩短显著相关。尿比重和 PCV 与生存时间延长显著相关。
结论和临床意义
与甲状腺功能亢进相关的蛋白尿不是 CKD 进展的中介物；然而，它确实与全因死亡率相关。
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