犬急性胰臟炎之研究: I 嚴重程度評分系統之建立 II 新鮮冷凍血漿治療效果之評估

Abstract

本研究收集自2009年1月至2012年6月間，SNAPR cPL TM Test陽性，診斷為犬胰臟炎之126隻患犬。統計結果顯示，患犬大於8歲、出現低體溫(<37.5℃)或寡尿等臨床症狀，或同時罹患糖尿病酮酸血症，或出現全身性炎症反應症候群(systemic inflammatory response syndrome，簡稱SIRS)、腎臟損傷(renal injury)、瀰漫性血管內凝血(disseminated intravascular coagulation，簡稱DIC)等併發症時，死亡率顯著上升。將患犬依預後結果分為死亡組(n=56)與存活組(n=70)進行血檢比較。死亡組於到院48小時的RBC數值顯著低於存活組，WBC、總膽紅素、BUN與creatinine的數值則顯著高於存活組。死亡組的血小板與RBC隨病程惡化逐漸減少，存活組的血小板則隨疾病緩解逐漸上升，同時WBC、總膽紅素、BUN與creatinine隨疾病緩解呈下降趨勢。 總結預後相關之項目為體溫(BT)、肌酸酐(creatinine)、總膽紅素(total bilirubin)、紅血球(RBC)、白血球(WBC)、白血球型態(morphology of WBC)、血小板(platelets)、年齡(age)、同時罹患之疾病(concurrent diseases)與犬胰臟炎相關併發症(complications)。依到院48小時累計積分與死亡率之關係區分其嚴重程度：小於11分為輕度、11-17分為中度、大於17分為重度。依上述區分之輕度、中度與重度患犬死亡率分別為5% (3/62)、71% (27/38)與100% (26/26)；三者間分別有顯著差異(p＜0.05)。顯示此評分系統可區分不同嚴重程度之胰臟炎患犬。 本研究依新建立的犬胰臟炎嚴重程度評分表，進行新鮮冷凍血漿(fresh frozen plasma, 簡稱FFP)於犬胰臟炎治療效果回溯性分析，Group 1(n=48)為接受FFP與對症支持治療組，Group 2 (n=78)為僅接受對症支持治療組。發現嚴重程度為輕度之FFP組與對照組的存活率分別是100%與93%；中度之FFP組與對照組的存活率各為47%與17%；重度FFP組與對照組的患犬皆死亡。輕度與重度FFP組與對照組的患犬存活率無顯著差異，中度患犬則有統計上顯著差異。進行生存分析計算其累積生存率，顯示中度患犬FFP組的累積生存率比對照組高，且生存時間顯著大於對照組(p＜0.05)。此外，中度組FFP組接受靜脈注射新鮮冷凍血漿三天後，分數下降程度顯著大於Group 2b (p＜0.05)。 總結，本研究所建立之犬胰臟炎嚴重程度評分系統，可做為臨床預後評估及治療策略選擇之參考。依此評分系統區分患犬之嚴重程度，證實合併FFP之治療方式，可快速緩解輕至中度患犬之疾病嚴重程度，進而顯著提升其存活率。

126 dogs diagnosed as canine pancreatitis by clinical signs and a positive SNAPR cPL TM Test, between January 2009 and June 2012 were collected in this study. Greater than 8 years of age, hypothermia (<37.5 ℃), oliguria, concurrent with diabetes ketoacidosis and development of complications such as systemic inflammatory response syndrome (SIRS), renal injury or disseminated intravascular coagulation (DIC) were significantly associated with higher mortality (P<0.05) . The RBC counts of non-survival group (n=56) was significantly lower, and the WBC counts, total bilirubin, BUN and creatinine levels were significantly higher than the survival group (n=70) at 48 hours after admission. The platelet and RBC counts of non- survival group decreased with disease progression. In contrast, WBC counts, total bilirubin, BUN and creatinine levels of survival group decreased with disease remission. Body temperature (BT), creatinine, total bilirubin levels, RBC, WBC, platelet counts , morphology of WBC, age, concurrent diseases and complications exhibited good correlation with prognosis and disease severity. Based on the mentioned, assessment criteria for the severity of pancreatitis was developed. Cumulative points less than 11 were assigned as a mild group, while cumulative points ranging from 11 to 17 were assigned as a moderate group and points in excess of 17 were assigned as a severe group. The mortalities of mild, moderate and severe groups were 5% (3/62), 71% (27/38) and 100% (26/26), respectively. There were significant differences among the each three groups (p＜0.05). These criteria could be used to assess the severity of pancreatitis at 48 hours after admission in a clinical setting. The dogs in the group 1 (n=48) were treated with combination of fresh frozen plasma (FFP) and supportive therapy. The dogs in the group 2 (n=78) were only treated with supportive therapy. The survival rates were 100% and 93% in group 1a and group 2a (mild group), 47% and 17% in group 1b and group 2b (moderate group) and none survival in group 1c and group 2c (severe group). There were no significant differences of survival rate between group 1a and group 2a, group 1c and 2c; however, the survival rate of group 1b was significant higher than group 2b. Both Kaplan- meier survival analysis and cumulative survivial rate were significant (p＜0.05) higher in Group 1b than in Group 2b (moderate group). In conclusions, assessment criteria, including body temperature (BT), creatinine, total bilirubin, RBC, WBC, platelet counts, morphology of WBC, age, concurrent diseases and complications can be used to predict disease severity and prognosis of acute pancreatitis. Treatment combined with FFP could be used to improve survival rate of the mild to moderate group significantly.