慢性退化性二尖瓣疾病患犬發生心因性惡病質之盛行率及死亡相關危險因子之研究

Abstract

惡病質是一種臨床症候群常見於各類慢性疾病，如慢性心衰竭，其臨床症狀包括虛弱、食慾下降、消瘦、貧血及低蛋白血症及腎功能不全等。造成惡病質的致病機轉相當複雜，主要由慢性炎症反應相關的細胞激素和為代償心臟病而分泌的神經荷爾蒙所引發。在患有慢性心衰竭的病人已證實:若出現惡病質及相關症狀則其預後較差，即惡病質為死亡預測因子。目前惡病質在罹患慢性退化性二尖瓣疾病的犬隻的發生情況及影響尚未清楚明瞭，本研究的目的是評估犬慢性退化性二尖瓣疾病發生惡病質的流行率以及惡病質相關因子對該疾病存活率的影響。流行率的評估包含25隻健康犬隻和114隻患有慢性退化性二尖瓣疾病的犬隻並依照紐約心臟協會分級系統修正版 (modified New York Heart Association functional classification) 加以分級。其中106隻患有慢性退化性二尖瓣疾病的犬隻進行18個月追蹤完成惡體質相關因子對該疾病存活率的影響。 總體而言，惡病質的流行率為32.5%。惡病質、貧血及氮血症的盛行率隨著心衰竭較嚴重升高。而低白蛋白血症之盛行率與心臟病的嚴重程度無關。心衰竭症狀的嚴重程度、惡病質、貧血、體重減輕、低蛋白血症及氮血症均為死亡預測因子。

Cachexia is a common in chronic diseases including heart failure in human and canine patients with heart failure. It is a general syndrome which is characterized by progressive weight loss, anemia, malnutrition and renal dysfunction resulting from the complex mechanism of inflammation and neurohormones. Cardiac cachexia and theses parameters are also the predictors of mortality in human patients. The impact of cachexia in dogs with chronic degenerative mitral valvular disease (CDMD) is poorly understood. The aims were to evaluate the prevalence and presence of cardiac cachexia in dogs with CDMD. Twenty-five clinically healthy dogs and 114 CDMD dogs categorized by modified New York Heart Association functional classification (NYHA) were included for prevalence evaluation of cardiac cachexia, and 106 CDMD dogs completed the 18-month follow-up for survival analysis of cardiac cachexia associated factors. In general, the prevalence of cachexia was 32.5% in CDMD dogs, prevalence of cardiac cachexia, anemia and azotemia increased with severity of heart failure. The difference of hypoalbuminemia was not significant between healthy controls and CDMD dogs. Severity, cardiac cachexia, weight loss, anemia, hypoalbuminemia and azotemia were predictive factors of mortality in CDMD dogs.