Buckley Faith I, Mahony Orla, Webster Cynthia R L
Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA.
J Vet Diagn Invest. 2017 Jan;29(1):14-19. doi: 10.1177/1040638716671978. Epub 2016 Nov 16.
Cats with cholestatic liver disease experience significant morbidity and mortality when they undergo invasive procedures under anesthesia. Although inadequate adrenal response might account for these outcomes, adrenal function in cats with cholestatic liver disease has not been documented, to our knowledge. The goal of our study was to describe adrenal function in these cats. Twenty-seven cats with a serum bilirubin >230 µmol/L (3 mg/dL) and serum alanine aminotransferase >2 times the upper limit of normal had pre- and 60-min post-adrenocorticotropic hormone (ACTH) cortisol analysis after administration of 5 µg/kg cosyntropin intravenously. The change in cortisol concentrations (delta cortisol) was calculated. Pre- and post-ACTH cortisol concentrations were compared to reference values. Pre-ACTH, post-ACTH, and delta cortisol values were compared between cats surviving to discharge or for 30 d postdischarge. Mean pre-ACTH cortisol levels (205 ± 113 nmol/L [7.4 ± 4.2 µg/dL]) and post-ACTH cortisol levels (440 ± 113 nmol/L [15.9 ± 4.1 g/dL]) in cholestatic cats were significantly greater than reference values in clinically normal cats. There was no association of pre- or post-ACTH cortisol with survival. Cats with a delta cortisol <179 nmol/L (6.5 µg/dL) were more likely to be non-survivors at 30 d post-discharge ( p = 0.037) than cats with delta cortisol >179 nmol/L (6.5 µg/dL). Results indicate that cats with cholestasis have high basal and ACTH-stimulated cortisol values. A delta cortisol <179 nmol/L (6.5 µg/dL) defines a population of cats that have decreased 30-d survival.
患有胆汁淤积性肝病的猫在接受麻醉下的侵入性手术时，会经历显著的发病率和死亡率。尽管肾上腺反应不足可能是导致这些结果的原因，但据我们所知，胆汁淤积性肝病猫的肾上腺功能尚未得到记录。我们研究的目的是描述这些猫的肾上腺功能。27只血清胆红素>230 µmol/L（3 mg/dL）且血清丙氨酸氨基转移酶>正常上限2倍的猫，在静脉注射5 µg/kg促肾上腺皮质激素（ACTH）后，进行了ACTH注射前和注射后60分钟的皮质醇分析。计算了皮质醇浓度的变化（皮质醇变化量）。将ACTH注射前和注射后的皮质醇浓度与参考值进行比较。比较了存活至出院或出院后30天的猫的ACTH注射前、注射后和皮质醇变化量值。胆汁淤积性猫的平均ACTH注射前皮质醇水平（205±113 nmol/L [7.4±4.2 µg/dL]）和ACTH注射后皮质醇水平（440±113 nmol/L [15.9±4.1 µg/dL]）显著高于临床正常猫的参考值。ACTH注射前或注射后的皮质醇与存活率无关。皮质醇变化量<179 nmol/L（6.5 µg/dL）的猫在出院后30天内比皮质醇变化量>179 nmol/L（6.5 µg/dL）的猫更有可能死亡（p = 0.037）。结果表明，胆汁淤积性猫具有较高的基础皮质醇值和ACTH刺激的皮质醇值。皮质醇变化量<179 nmol/L（6.5 µg/dL）定义了一组30天存活率降低的猫。
