Tadros E M, Fowlie J G, Refsal K R, Marteniuk J, Schott H C
Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan, USA.
Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA.
Equine Vet J. 2019 Jan;51(1):52-56. doi: 10.1111/evj.12963. Epub 2018 Jun 20.
Hyperinsulinaemia is the suspected component of insulin dysregulation having the strongest association with laminitis and occurs variably in equids with pituitary pars intermedia dysfunction (PPID).
We hypothesised that magnitude of hyperinsulinaemia correlates with laminitis severity in PPID-affected equids. Furthermore, we hypothesised that owners can be unaware of chronic endocrinopathic laminitis.
Cross-sectional study.
Serum insulin concentrations, owner-reported laminitis history and radiographic evidence of laminitis were determined in 38 client-owned horses and ponies with confirmed PPID. Laminitis severity was classified into four categories (normal [nonlaminitic], mild, moderate or severe laminitis) based on degree of distal phalangeal rotation. Animals were also categorised as normoinsulinaemic (<20 μU/ml), mildly hyperinsulinaemic (20-50 μU/ml) and severely hyperinsulinaemic (>50 μU/ml). One-way ANOVA, t tests and Fisher's exact tests were performed.
While owners reported laminitis in 37% of animals, 76% were laminitic based on study criteria (P = 0.01). Owners reported laminitis more frequently in hyperinsulinaemic vs. normoinsulinaemic animals; recognition increased with severity of hyperinsulinaemia (P = 0.03). Mean insulin concentrations were higher in equids with moderate to severe radiographic laminitis (geometric mean 74.1, 95% confidence interval (CI) 38.4-143.1 uU/ml) vs. those classified radiographically as normal to mild (31.9, 95% CI 21.1-48.1 uU/ml P = 0.03).
Dynamic insulin testing was not performed; some normoinsulinaemic animals might have had subtle insulin dysregulation.
Although radiographic abnormalities were present in most animals at the time of PPID diagnosis, chronic laminitis remained unrecognised by many owners. Owner awareness of laminitis increased with severity of hyperinsulinaemia and higher insulin concentrations were detected in association with more severe radiographic changes. The Summary is available in Chinese - See Supporting Information.
高胰岛素血症被怀疑是胰岛素调节异常的一个组成部分，与蹄叶炎的关联最为紧密，并且在患有垂体中间叶功能障碍（PPID）的马属动物中表现各异。
我们假设在受PPID影响的马属动物中，高胰岛素血症的程度与蹄叶炎的严重程度相关。此外，我们假设主人可能未意识到慢性内分泌性蹄叶炎。
横断面研究。
对38匹确诊患有PPID的客户拥有的马和矮种马测定血清胰岛素浓度、主人报告的蹄叶炎病史以及蹄叶炎的影像学证据。根据远节趾骨旋转程度，将蹄叶炎严重程度分为四类（正常[非蹄叶炎]、轻度、中度或重度蹄叶炎）。动物也被分为正常胰岛素血症（<20 μU/ml）、轻度高胰岛素血症（20 - 50 μU/ml）和重度高胰岛素血症（>50 μU/ml）。进行了单因素方差分析、t检验和费舍尔精确检验。
虽然主人报告37%的动物患有蹄叶炎，但根据研究标准76%的动物患有蹄叶炎（P = 0.01）。主人报告高胰岛素血症动物比正常胰岛素血症动物更频繁发生蹄叶炎；随着高胰岛素血症严重程度增加，识别率也增加（P = 0.03）。与影像学分类为正常至轻度的动物相比，中度至重度影像学蹄叶炎的马属动物平均胰岛素浓度更高（几何平均数74.1，95%置信区间[CI] 38.4 - 143.1 uU/ml）（31.9，95% CI 21.1 - 48.1 uU/ml，P = 0.03）。
未进行动态胰岛素检测；一些正常胰岛素血症动物可能存在细微的胰岛素调节异常。
虽然在PPID诊断时大多数动物存在影像学异常，但许多主人仍未认识到慢性蹄叶炎。主人对蹄叶炎的认知随着高胰岛素血症严重程度增加而提高，并且与更严重的影像学变化相关联，检测到更高的胰岛素浓度。中文摘要见支持信息。
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