de Laat Melody A, Reiche Dania B, Sillence Martin N, McGree James M
Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.
Animal Health, Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany.
J Vet Intern Med. 2019 May;33(3):1473-1482. doi: 10.1111/jvim.15497. Epub 2019 Apr 10.
Endocrinopathic laminitis is common in horses and ponies, but the recurrence rate of the disease is poorly defined.
To determine the incidence of, and risk factors for, the recurrence of endocrinopathic laminitis.
Privately owned horses and ponies with acute laminitis (n = 317, of which 276 cases with endocrinopathic laminitis were followed up to study completion).
This prospective cohort study collected data on veterinary-diagnosed cases of acute laminitis for 2 years. Each case was classified on acceptance to the study as endocrinopathic or non-endocrinopathic using data collected in a questionnaire completed by the animal's veterinarian. Follow-up data were collected at regular intervals to determine whether the laminitis recurred in the 2-year period after diagnosis.
The recurrence rate for endocrinopathic laminitis was 34.1%. The risk of recurrence during the 2-year study period increased with basal, fasted serum insulin concentration (P ≤ .05), with the probability of recurrence increasing markedly as the insulin concentration increased beyond the normal range (0-20 μIU/mL) to over the threshold for normal (up to approximately 45 μIU/mL). Being previously diagnosed with laminitis (before the study; P = .05) was also a risk factor for recurrent laminitis. Cases with a higher Obel grade of laminitis were likely (P = .05) to recur sooner.
Knowing that hyperinsulinemia and being previously diagnosed with laminitis are significant risk factors for recurrence will enable clinicians to proactively address these factors, thereby potentially reducing the risk of recurrence of laminitis.
内分泌性蹄叶炎在马和矮种马中很常见，但该病的复发率尚不明确。
确定内分泌性蹄叶炎复发的发生率及危险因素。
患有急性蹄叶炎的私人拥有的马和矮种马（n = 317，其中276例内分泌性蹄叶炎病例随访至研究结束）。
这项前瞻性队列研究收集了2年兽医诊断的急性蹄叶炎病例的数据。根据动物兽医填写的问卷中收集的数据，将每个病例在纳入研究时分类为内分泌性或非内分泌性。定期收集随访数据，以确定蹄叶炎在诊断后的2年内是否复发。
内分泌性蹄叶炎的复发率为34.1%。在2年研究期间，复发风险随着基础空腹血清胰岛素浓度的升高而增加（P≤0.05），随着胰岛素浓度超过正常范围（0 - 20 μIU/mL）并超过正常阈值（高达约45 μIU/mL），复发概率显著增加。之前被诊断为蹄叶炎（研究前；P = 0.05）也是蹄叶炎复发的一个危险因素。蹄叶炎Obel分级较高的病例更有可能（P = 0.05）更快复发。
了解高胰岛素血症和之前被诊断为蹄叶炎是复发的重要危险因素，将使临床医生能够积极应对这些因素，从而有可能降低蹄叶炎复发的风险。
