自然感染之貓傳染性腹膜炎臨床與實驗室檢查之研究

Abstract

本研究收集51隻經由屍解病理學確診的自然感染貓傳染性腹膜炎(feline infectious peritonitis，簡稱FIP)發病貓的基本資料及一系列的各項檢驗結果進行研究，找尋可供臨床上病程分級之參考。30隻貓(30/51, 58.8%)為濕式FIP，12隻貓(12/51, 23.5%)為乾式FIP，另外9隻貓(9/51, 17.6%)為混合式FIP。年齡分布由3個月大至7歲，一歲以下小貓佔74.5% (38/51)為最大量。發病公貓與母貓比例為49% (25/51)與51% (26/51)，無顯著差異。初次就診常見食慾下降(55.6~75%)、發燒(50~77.8%)和精神沉鬱(33.3~60%)等臨床症狀。使用RT-PCR檢測貓冠狀病毒時，胸水和腹水有較高檢出率，分別為100% (9/9)和94.4% (17/18)，直腸拭子於乾式和濕式FIP也有較高檢出率，為66.7% (12/18)和60% (18/30)。隨病程進展臨床病理學會出現貧血、淋巴球減少、高膽紅素血症、低白蛋白血症、高蛋白血症、ALT及AST升高、低血鈉及低血鉀等異常。無論乾濕式FIP貓比較其初次就診與死前0-3天之血檢，可發現血容比由26.5±7.0%降至17.0±4.6%、膽紅素由0.7±1.0 mg/dL升為2.5±1.3 mg/dL、白蛋白由2.5±0.3 g/dL降至2.2±0.4 g/dL，皆有極顯著差異(p<0.01)；總蛋白質由8.1±1.4 g/dL降至7.3±1.7 g/dL、ALT由61±69 U/L升為160±177 U/L、AST由170±215 U/L升為562±348 U/L，亦皆有顯著差異(p<0.05)。而在濕式FIP組的一系列血檢比較中，死前兩週至死前0-3天之間，慢慢由輕微至中度貧血(25.8±6.3%)，變化為中度至嚴重貧血(17.2±4.3%)，同時膽紅素逐漸升高(由0.5±0.4 mg/dL升為2.8±1.2 mg/dL)，AST逐漸上升(由103±63 U/L升為673±322 U/L)，皆達極顯著差異(p<0.01)。在死前一週與死前0-3天之間，膽紅素和AST會出現劇烈變化(p<0.01)，分別由1.0±.0.9 mg/dL升為2.8±1.2 mg/dL及141±48 U/L升為673±322 U/L。血漿總蛋白質和開始治療後之存活時間有正相關性(p=0.0017)，相關係數為0.45557；血漿球蛋白和開始治療後之存活時間也有正相關性(p=0.0032)，相關係數為0.42981。初次就診時，FIP貓若有較高的血漿總蛋白質含量以及較高的血漿球蛋白含量，顯示有較長的存活時間。綜合上述，臨床病理學檢驗可提供作為客觀評估病程的分級參考及預測存活時間，其中以血容比(PCV)、膽紅素(total bilirubin)和天門冬胺酸轉胺酶(AST)的變化更可準確的提供作為病程預測的因子。

Fifty-one naturally infected feline infectious peritonitis (FIP) diseased cats were enrolled in this study for staging of the course of FIP disease. Effusive FIP was found in 30/51 cats (58.8%), whereas non-effusive FIP was diagnosed in 12/51 cats (23.5%), and nine cats (9/51, 17.6%) were mixed type. The age ranged from 3 month-old to 7 year-old. Most of them were less than 1-year-old (38/51, 74.5%). Twenty-five of 51 (49%) cats with FIP were male while 26 (51%) were female. There was no gender prevalence. Anorexia (55.6~75%), fever (50~77.8%), and depression (33.3~60%) were the major clinical signs at presenting. Higher detection rate of coronavirus by RT-PCR was found in pleural effusion (9/9, 100%), ascites (17/18, 94.4%), and rectal swabs (66.7% in non-effusive FIP, 60% in effusive FIP). The clinicopathological changes include anemia, lymphopenia, hyperbilirubinemia, hypoalbuminemia, hyperproteinemia, elevation of ALT and AST, hyponatremia, and hypokalemia. Highly significant (p<0.01) decreasing of hematocrit (26.5±7.0% to 17.0±4.6%), elevation of total bilirubin (0.7±1.0 mg/dL to 2.5±1.3 mg/dL), and decreasing of albumin (2.5±0.3 g/dL to 2.2±0.4 g/dL) were noted in both effusive and non-effusive FIP at presenting and 0-3 days before death. Meanwhile, significant (p<0.05) decreasing of total protein (8.1±1.4 g/dL to 7.3±1.7 g/dL), elevation of ALT (61±69 U/L to 160±177 U/L) and AST(170±215 U/L to 562±348 U/L) were also observed. In the serial blood examinations in effusive group, variation of anemia (25.8±6.3% to 17.2±4.3%, p<0.01), increasing of total bilrubin (0.5±0.4 mg/dL to 2.8±1.2 mg/dL, p<0.01) and AST (103±63 U/L to 673±322 U/L, p<0.01) were observed between 2 weeks and 0 to 3 days before death. Total bilirubin (1.0±0.9 mg/dL to 2.8±1.2 mg/dL, p<0.01) and AST (141±48 U/L to 673±322 U/L, p<0.01) increased dramatically between 1 week and 0 to 3 days before death. The correlation coefficients were 0.45557 (P=0.0017) between TP and survival time after diagnosis and 0.42981 (P=0.0032) between globulin and survival time after diagnosis. Patients with higher TP and globulin at presenting could be survival longer. In conclusion, clinicopathological finding could provide an objective evaluation in the course of disease. The change of hematocrit, bilirubin and AST were more precise to forecast the course of FIP.