Clark B L, Stewart A J, Kemp K L, Bamford N J, Bertin F-R
The University of Queensland, 5391 Warrego Hwy, Gatton, QLD 4343, Australia.
The University of Queensland, 5391 Warrego Hwy, Gatton, QLD 4343, Australia.
Vet J. 2023 Aug-Sep;298-299:106019. doi: 10.1016/j.tvjl.2023.106019. Epub 2023 Aug 1.
Field tests and their association with laminitis have not been evaluated in large cohorts. The objectives of this study were to evaluate the performance of basal insulin (BI), the oral sugar test (OST) and the insulin tolerance test (ITT) to diagnose ID and investigate their association with laminitis. Insulin dysregulation status was determined in 146 ponies using BI (insulin concentration >20 µIU/mL), an OST (insulin concentration >65 µIU/mL at 60 or 90 min after oral administration of 0.45 mL/kg corn syrup) and an ITT (< 50% reduction in glucose concentration 30 min after intravenous administration of 0.1 IU/kg insulin). Laminitis was identified using modified-Obel scores. A Bayesian approach was used to define the characteristics of the tests and receiver operating characteristic curves were used to assess their association with laminitis. All tests were well tolerated and laminitis was diagnosed in 9% of ponies. Insulin dysregulation was diagnosed in 15% of ponies using BI, 38% using the OST and 54% using the ITT with 11% of ponies positive for all three tests. The sensitivities and specificities of BI, the OST and the ITT to diagnose ID were 0.52 (95% confidence interval [CI], 0.35-0.79) and 0.97 (95% CI, 0.91 - 1.00), 0.84 (95% CI, 0.70 - 0.94) and 0.60 (95% CI, 0.49 - 0.71), and 0.85 (95% CI, 0.68-0.96) and 0.88 (95% CI, 0.75 - 0.97), respectively. Only BI and the OST were associated with laminitis (P = 0.003 and 0.015, respectively).
尚未在大型队列中评估现场试验及其与蹄叶炎的关联。本研究的目的是评估基础胰岛素（BI）、口服糖试验（OST）和胰岛素耐量试验（ITT）在诊断胰岛素失调（ID）方面的性能，并调查它们与蹄叶炎的关联。使用BI（胰岛素浓度>20 µIU/mL）、OST（口服0.45 mL/kg玉米糖浆后60或90分钟时胰岛素浓度>65 µIU/mL）和ITT（静脉注射0.1 IU/kg胰岛素后30分钟时葡萄糖浓度降低<50%）测定了146匹小马的胰岛素失调状态。使用改良的奥贝尔评分来确定蹄叶炎。采用贝叶斯方法来定义试验的特征，并使用受试者工作特征曲线来评估它们与蹄叶炎的关联。所有试验的耐受性良好，9%的小马被诊断为蹄叶炎。使用BI诊断出15%的小马存在胰岛素失调，使用OST诊断出38%，使用ITT诊断出54%，11%的小马三项试验均为阳性。BI、OST和ITT诊断ID的敏感性和特异性分别为0.52（95%置信区间[CI]，0.35 - 0.79）和0.97（95%CI，0.91 - 1.00）、0.84（95%CI，0.70 - 0.94）和0.60（95%CI，0.49 - 0.71）、0.85（95%CI，0.68 - 0.96）和0.88（95%CI，0.75 - 0.97）。只有BI和OST与蹄叶炎相关（P分别为0.003和0.015）。
