Braun Ueli, Nuss Karl, Oschlies Carina, Reif Christina, Warislohner Sonja, Gerspach Christian
Departement für Nutztiere, Vetsuisse-Fakultät, Universität Zürich.
Tierarztl Prax Ausg G Grosstiere Nutztiere. 2022 Apr;50(2):91-100. doi: 10.1055/a-1809-1042. Epub 2022 May 6.
A number of laboratory abnormalities occurs in cows with traumatic reticuloperitonitis (TRP) as well as in those with abomasal ulcers (U; classified as type 1 to 5). The goal of our study was to compare the frequency of individual laboratory variables of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine the diagnostic significance of individual laboratory variables.
The present study included 182 healthy control cows, 503 cows with TRP, 94 cows with U1, 145 cows with U2, 60 cows with U3, 87 cows with U4 and 14 cows with U5. Hematocrit, total leukocyte count, concentrations of total protein, fibrinogen, urea, potassium and chloride, base excess and rumen chloride concentration were analyzed. The frequency distributions of all variables for all groups of cows were compared and the diagnostic reliabilities (diagnostic sensitivities and specificities, predictive values, positive likelihood ratios [LR]) were calculated.
Values outside the reference interval occurred in 2 to 24 % of control cows (rumen chloride 2 %, urea 6 %, serum chloride 11 %, hematocrit 13 %, base excess 18 %, fibrinogen 20 %, total protein 21 %, total leukocyte count 22 % and potassium 24 %), which made differentiation of healthy and ill cows difficult. Therefore, the variables best suited for distinguishing healthy and affected cows were rumen chloride and blood urea concentration. This was also supported by an LR of 14 to 27 for rumen chloride > 30 mmol/l and 6 to 15 for blood urea > 6.5 mmol/l in cows with abomasal ulcers. Urea also displayed a high diagnostic specificity and was suited for differentiation of healthy and diseased cows. The urea concentration was > 8.5 mmol/l in only 0.5 % of controls, and the LR for a urea concentration > 8.5 mmol/l ranged from 11 in cows with TRP to 128 in cows with U2. Except for cows with TRP, azotemia was significantly more frequent in affected cows than in controls. Cows with U2 (70 %) had urea concentrations > 8.5 mmol/l significantly more frequently than cows of the other groups. Even though the groups of diseased cows differed significantly with respect to several variables, no variables were identified to reliably differentiate the various groups.
Different disorders in cows cannot be differentiated based on single laboratory variables.
For a definitive diagnosis the history, clinical findings and results of additional diagnostic techniques such as radiography of the reticulum, ultrasonography and abdominocentesis are required. In many cases, a definitive diagnosis can only be made via exploratory laparotomy and/or postmortem examination.
创伤性网胃炎(TRP)奶牛以及真胃溃疡(U,分为1至5型)奶牛会出现一些实验室检查异常。我们研究的目的是比较创伤性网胃炎奶牛和真胃溃疡奶牛各项实验室检查指标的出现频率,并确定各项实验室检查指标的诊断意义。
本研究纳入了182头健康对照奶牛、503头患TRP的奶牛、94头患U1的奶牛、145头患U2的奶牛、60头患U3的奶牛、87头患U4的奶牛以及14头患U5的奶牛。分析了血细胞比容、白细胞总数、总蛋白、纤维蛋白原、尿素、钾和氯的浓度、碱剩余以及瘤胃液氯浓度。比较了所有奶牛组各项指标的频率分布,并计算了诊断可靠性(诊断敏感性和特异性、预测值、阳性似然比[LR])。
对照奶牛中2%至24%的个体出现超出参考区间的值(瘤胃液氯2%、尿素6%、血清氯11%、血细胞比容13%、碱剩余18%、纤维蛋白原20%、总蛋白21%、白细胞总数22%以及钾24%),这使得区分健康奶牛和患病奶牛变得困难。因此,最适合区分健康奶牛和患病奶牛的指标是瘤胃液氯和血尿素浓度。真胃溃疡奶牛瘤胃液氯>30 mmol/L时的LR为14至27,血尿素>6.5 mmol/L时的LR为6至15,这也支持了上述结论。尿素也具有较高的诊断特异性,适合区分健康奶牛和患病奶牛。对照组中只有0.5%的奶牛尿素浓度>8.5 mmol/L,尿素浓度>8.5 mmol/L时TRP奶牛的LR为11,U2奶牛的LR为128。除TRP奶牛外,患病奶牛的氮血症明显比对照奶牛更常见。U2奶牛(70%)尿素浓度>8.5 mmol/L的频率明显高于其他组奶牛。尽管患病奶牛组在几个指标上存在显著差异,但未发现能可靠区分不同组别的指标。
不能基于单一实验室检查指标区分奶牛的不同疾病。
为明确诊断,需要病史、临床检查结果以及其他诊断技术(如网胃造影、超声检查和腹腔穿刺术)的结果。在许多情况下,只有通过剖腹探查术和/或尸体剖检才能做出明确诊断。