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[犬中性粒细胞减少症:病因及预后因素]

[Neutropenia in dogs: etiology and prognostic factors].

作者信息

Cook Andrea M, Bauer Natali, Neiger Reto, Peppler Christine, Moritz Andreas

机构信息

Andrea Manuela Cook, Berrenrather Straße 1a, 50169 Kerpen, E-Mail:

出版信息

Tierarztl Prax Ausg K Kleintiere Heimtiere. 2016 Oct 12;44(5):307-315. doi: 10.15654/TPK-160142. Epub 2016 Aug 16.

Abstract

OBJECTIVE

The aim of this retrospective study was to evaluate frequency, prognostic factors, and differences for various etiologies of neutropenia in dogs.

MATERIAL AND METHODS

A total of 391 dogs with neutrophil counts < 2.78 x 10/l (January 2008 to December 2012) were included and, depending on the etiology of neutropenia, assigned to seven diagnostic groups: nonbacterial infectious disease, increased demand due to marked inflammation, drug-associated, bone-marrow diseases, immune-mediated, physiologic, miscellaneous. Absolute neutrophil counts, evidence of neutrophil toxicity or left shift, case history, rectal temperature, hospitalization, and survival were compared among groups.

RESULTS

Increased demand due to marked inflammation (90/391, 23%) and nonbacterial infectious disease (70/391, 18%) were the most common causes for neutropenia, followed by drug-associated neutropenia (43/391, 11%) and bone-marrow disease (32/391, 8%). Immune-mediated and physiologic neutropenia (both 16/391, 4%) were uncommon. Almost one third (124/391, 32%) of dogs were assigned to the miscellaneous group. Absolute neutrophil counts were significantly higher (p < 0.01) in dogs of the physiologic and miscellaneous groups than in the other groups. Dogs with immune-mediated neutropenia or nonbacterial infectious disease displayed significantly lower absolute neutrophil counts than dogs with neutropenia due to an increased demand (p < 0.001) and were most commonly referred with a history of fever (11/16, 69%) or gastrointestinal signs (52/70, 74%), respectively. Neutrophil toxicity and left shift were most commonly associated with an increased demand due to marked inflammation (60/90 and 25/90, 67% and 28%, respectively) and the mortality rate was highest in this group (32/90, 36%).

CONCLUSION

Neutrophil toxicity and left shift are associated with an increased demand due to marked inflammation and may indicate a poor prognosis. The lower the absolute neutrophil count, the greater the probability of an immune-mediated neutropenia.

CLINICAL RELEVANCE

Neutropenia should be assessed in context with case history, clinical examination, and neutrophil morphology.

摘要

目的

本回顾性研究旨在评估犬中性粒细胞减少症的各种病因的发生率、预后因素及差异。

材料与方法

纳入了391只中性粒细胞计数<2.78×10⁹/L的犬(2008年1月至2012年12月),并根据中性粒细胞减少症的病因分为七个诊断组:非细菌性传染病、因显著炎症导致需求增加、药物相关性、骨髓疾病、免疫介导性、生理性、其他。比较各诊断组间的绝对中性粒细胞计数、中性粒细胞毒性或核左移证据、病史、直肠温度、住院情况及生存率。

结果

因显著炎症导致需求增加(90/391,23%)和非细菌性传染病(70/391,18%)是中性粒细胞减少症最常见的病因,其次是药物相关性中性粒细胞减少症(43/391,11%)和骨髓疾病(32/391,8%)。免疫介导性和生理性中性粒细胞减少症(均为16/391,4%)不常见。近三分之一(124/391,32%)的犬被归入其他组。生理性和其他组犬的绝对中性粒细胞计数显著高于其他组(p<0.01)。免疫介导性中性粒细胞减少症或非细菌性传染病的犬的绝对中性粒细胞计数显著低于因需求增加导致中性粒细胞减少症的犬(p<0.001),且最常分别以发热史(11/16,69%)或胃肠道症状(52/70,74%)转诊。中性粒细胞毒性和核左移最常与因显著炎症导致需求增加相关(分别为60/90和25/90,67%和28%),且该组死亡率最高(32/90,36%)。

结论

中性粒细胞毒性和核左移与因显著炎症导致需求增加相关,可能提示预后不良。绝对中性粒细胞计数越低,免疫介导性中性粒细胞减少症的可能性越大。

临床意义

中性粒细胞减少症应结合病史、临床检查和中性粒细胞形态进行评估。

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