Patterson-Kane J C, Karikoski N P, McGowan C M
Flagship Biosciences, 7575 W 103rd Ave #102, Westminster, CO 80021, USA.
Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Viikintie49, FIN-00014 Helsinki, Finland.
Vet J. 2018 Jan;231:33-40. doi: 10.1016/j.tvjl.2017.11.011. Epub 2017 Nov 22.
Laminitis, one of the most debilitating conditions of all equids, is now known to be the result of several systemic disease entities. This finding, together with other recent developments in the field of laminitis research, have provoked a rethink of our clinical and research strategies for this condition. First, laminitis is now considered to be a clinical syndrome associated with systemic disease (endocrine disease, sepsis or systemic inflammatory response syndrome, SIRS) or altered weight bearing rather than being a discrete disease entity. Next, laminitis associated with endocrine disease (endocrinopathic laminitis) is now believed to be the predominant form in animals presenting (primarily) for lameness. Third, the designation of laminitis as a primary and severe basement membrane pathology now requires revision. Instead, current data now proposes a variable subclinical phase associated with gross changes in the hoof capsule, with stretching and elongation of the lamellar cells an early and key event in the pathophysiology. These findings have fuelled new mechanistic hypotheses and research directions that will be discussed, together with their implications for future clinical management.
蹄叶炎是所有马属动物中最使人衰弱的病症之一，目前已知它是多种全身性疾病实体导致的结果。这一发现，连同蹄叶炎研究领域的其他最新进展，促使我们重新思考针对这种病症的临床和研究策略。首先，蹄叶炎现在被认为是一种与全身性疾病（内分泌疾病、脓毒症或全身炎症反应综合征，即SIRS）或负重改变相关的临床综合征，而不是一种独立的疾病实体。其次，现在认为与内分泌疾病相关的蹄叶炎（内分泌性蹄叶炎）是（主要）因跛行就诊的动物中最主要的形式。第三，将蹄叶炎指定为原发性和严重的基底膜病变现在需要修正。相反，目前的数据表明存在一个与蹄匣明显变化相关的可变亚临床阶段，其中板层细胞的拉伸和延长是病理生理学中的一个早期关键事件。这些发现推动了新的机制假说和研究方向，本文将对其进行讨论，并阐述它们对未来临床管理的影响。
