Knowles Edward J, Elliott Jonathan, Harris Patricia A, Chang Yu-Mei, Menzies-Gow Nicola J
The Royal Veterinary College, Hatfield, UK.
Bell Equine Veterinary Clinic, Mereworth, UK.
Equine Vet J. 2023 Jan;55(1):12-23. doi: 10.1111/evj.13572. Epub 2022 Apr 1.
Quantifying risk factors for laminitis development requires improvement.
To identify the most useful physical examination, metabolic and management factors to predict laminitis development in client-owned, nonlaminitic ponies.
Prospective cohort study.
Physical examination, metabolic and management data were collected from a pony cohort 6 monthly for up to 4 years. Ponies were monitored for the development of laminitis. Metabolic data included basal plasma concentrations of ACTH ([ACTH]), adiponectin ([adiponectin]), triglycerides and glucose. Serum insulin concentrations ([insulin]) were measured in the unfasted basal state ([insulin]T0) and 60 minutes ([insulin]T60) after administration of corn syrup (0.3ml/kg). Separate multivariable Cox proportional-hazards models were developed for physical, management/signalment and metabolic data and later combined into two final models. Low-, medium- and high-laminitis risk categories were defined based on basal or T60 [insulin].
Overall, 374 ponies (age 5-32 years) and 891 pony-years were included in the main analysis. Laminitis incidence (95% confidence interval (CI)) was 4.8 (3.5-6.5) cases/100 pony-years. Laminitis development was associated with numerous univariable factors. Significant (P < .05) factors retained in the final multivariable models included [insulin]T0, [insulin]T60, [adiponectin] and divergent hoof growth. [ACTH] was not independently associated with laminitis. Based on [Insulin]T0, low- (<21.6 µIU/ml), medium- (21.6-45.2 µIU/ml) and high-risk (>45.2 µIU/ml) categories encompassed 70, 20 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 6 (2-9)%, 22 (10-33)% and 69 (48-82)% respectively. Based on [Insulin]T60 the low- (<53.4 µIU/ml), medium- (53.4-153 µIU/ml) and high-risk (≥153 µIU/ml) categories comprised 60, 30 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 3 (0-6)%, 20 (10-29)% and 73 (52-84)% respectively.
Results may not apply to different insulin assays, geographical regions, breeds or management types.
[Insulin]T0 or [insulin]T60 best quantify the risk of future laminitis development in nonlaminitic ponies.
量化蹄叶炎发生的风险因素仍需改进。
确定在客户拥有的非蹄叶炎小马中，预测蹄叶炎发生最有用的体格检查、代谢和管理因素。
前瞻性队列研究。
对一组小马每6个月收集一次体格检查、代谢和管理数据，持续4年。监测小马是否发生蹄叶炎。代谢数据包括促肾上腺皮质激素（[ACTH]）、脂联素（[脂联素]）、甘油三酯和葡萄糖的基础血浆浓度。在未禁食基础状态（[胰岛素]T0）和给予玉米糖浆（0.3ml/kg）后60分钟（[胰岛素]T60）测量血清胰岛素浓度（[胰岛素]）。分别为体格检查、管理/特征和代谢数据建立多变量Cox比例风险模型，随后合并为两个最终模型。根据基础或T60 [胰岛素]定义低、中、高蹄叶炎风险类别。
总体而言，主要分析纳入了374匹小马（年龄5 - 32岁）和891小马年。蹄叶炎发病率（95%置信区间（CI））为4.8（3.5 - 6.5）例/100小马年。蹄叶炎的发生与许多单变量因素相关。最终多变量模型中保留的显著（P <.05）因素包括[胰岛素]T0、[胰岛素]T60、[脂联素]和蹄生长差异。[ACTH]与蹄叶炎无独立相关性。基于[胰岛素]T0，低风险（<21.6 µIU/ml）、中风险（21.6 - 45.2 µIU/ml）和高风险（>45.2 µIU/ml）类别分别占总体的70%、20%和10%，估计4年蹄叶炎发病率（95%CI）分别为6（2 - 9）%、22（10 - 33）%和69（48 - 82）%。基于[胰岛素]T60，低风险（<53.4 µIU/ml）、中风险（53.4 - 153 µIU/ml）和高风险（≥153 µIU/ml）类别分别占总体的60%、30%和10%，估计4年蹄叶炎发病率（95%CI）分别为3（0 - 6）%、20（10 - 29）%和73（52 - 84）%。
结果可能不适用于不同的胰岛素检测方法、地理区域、品种或管理类型。
[胰岛素]T0或[胰岛素]T60能最好地量化非蹄叶炎小马未来发生蹄叶炎的风险。
