Langford Vets Small Animal Hospital, Bristol, United Kingdom.
J Vet Intern Med. 2024 May-Jun;38(3):1618-1625. doi: 10.1111/jvim.17088. Epub 2024 May 3.
Treatment options available for meningoencephalitis of unknown origin (MUO) in dogs are suboptimal, and currently, no single treatment protocol appears to be superior.
Compare neurological deterioration rates at 7 days between dogs with MUO treated with corticosteroids alone or combined with cytosine arabinoside (CA) continuous rate infusion (CRI) and compare clinical deterioration and survival at 30 and 100 days.
Sixty-nine dogs with magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) features or both compatible with MUO.
Parallel, blinded, randomized controlled trial. Simple randomization into 2 treatment groups: 4 mg/kg/day prednisolone (or dexamethasone equivalent) for 2 days or 200 mg/m CA CRI over 8 hours plus 2 mg/kg/day prednisolone. Blinding of the treatment protocol was carried out using reversible redaction of clinical records, and treatment failure was defined as deterioration of neurological assessment or death. Using intention-to-treat analysis, proportions failing treatment at 7, 30, and 100 days were compared using Fisher's exact test. All-cause mortality at 100 days was compared using Kaplan-Meier survival curves.
Thirty-five dogs were allocated to corticosteroid only, and 34 dogs were allocated to combined CA CRI and corticosteroid. Proportions failing treatment at 7, 30, and 100 days were 7/35 (20%), 9/35 (26%), and 15/35 (43%) in the corticosteroid-only group and 8/34 (24%), 11/34 (32%), and 23/34 (68%) in the corticosteroid and CA CRI group. All-cause mortality at 100 days was not significantly different between groups (P = .62). Clinically relevant treatment-related adverse effects were not observed.
We found no difference in outcome between corticosteroid monotherapy and combined cytarabine CRI and corticosteroid therapy at 7, 30, and 100 days after diagnosis in dogs with MUO.
目前针对犬不明原因脑膜脑炎（MUO）的治疗方法并不完善，且似乎没有任何单一的治疗方案具有优势。
比较单独使用皮质类固醇或联合阿糖胞苷（CA）持续率输注（CRI）治疗 MUO 的犬在第 7 天的神经恶化率，并比较第 30 天和第 100 天的临床恶化和生存情况。
69 只犬的磁共振成像（MRI）和脑脊液（CSF）表现或两者均符合 MUO 的特征。
平行、双盲、随机对照试验。简单随机分为 2 个治疗组：连续 2 天给予 4mg/kg/天泼尼松龙（或等效地塞米松）或 200mg/m CA CRI 输注 8 小时，然后给予 2mg/kg/天泼尼松龙。采用可逆性记录临床记录的方法对治疗方案进行盲法处理，治疗失败定义为神经评估恶化或死亡。采用意向治疗分析，使用 Fisher 确切检验比较第 7、30 和 100 天治疗失败的比例。使用 Kaplan-Meier 生存曲线比较第 100 天的全因死亡率。
35 只犬被分配到仅使用皮质类固醇组，34 只犬被分配到联合 CA CRI 和皮质类固醇组。仅使用皮质类固醇组在第 7、30 和 100 天的治疗失败比例分别为 7/35（20%）、9/35（26%）和 15/35（43%），联合 CA CRI 和皮质类固醇组分别为 8/34（24%）、11/34（32%）和 23/34（68%）。两组第 100 天的全因死亡率无显著差异（P=0.62）。未观察到与治疗相关的严重不良反应。
我们发现，在 MUO 犬诊断后第 7、30 和 100 天，皮质类固醇单药治疗与联合阿糖胞苷 CRI 和皮质类固醇治疗的结果无差异。
