- 學位論文
貓胰臟炎嚴重程度評分系統之建立與新鮮冷凍血漿治療效果之評估
The study of feline pancreatitis: 1. Establishment of severity scoring system 2. The therapeutic efficacy of fresh frozen plasma (FFP)
摘要
胰臟炎(pancreatitis)為貓隻最常見之胰臟外分泌腺疾病，由於胰臟炎嚴重程度範圍甚廣，為了迅速且正確評估嚴重程度，建立胰臟炎嚴重程度評分系統(severity scoring system)，本研究收集2011年10月至2013年9月間檢驗SNAP® fPL TM Test為陽性之43例貓胰臟炎，依存活(21/43, 48.8%)及死亡(22/43, 51.2%)進行統計分析，嚴重程度評分系統包含六項與貓胰臟炎預後相關的項目，分別為血紅素(hemoglobin)、白蛋白(albumin)、尿素氮(BUN)、總膽紅素(total bilirubin)、磷離子(phosphorous)及血壓(systolic blood pressure)，利用這些項目建立患貓恢復水合狀態之嚴重程度評分系統。此評分系統之接受者操作特徵曲線下面積(area under receiver-operating characteristic curve, AUROC)為0. 969，判別胰臟炎預後結果的最佳切點為總分17.5分，其敏感性(sensitivity) 95.2%及特異性(specificity) 95.5%，當分數等於或小於17分時，患貓死亡率為4.8%，當分數等於或大於18分時，患貓死亡率則增為95.5%。此外，存活組隨著水合狀態恢復，其嚴重程度逐漸下降，然而死亡組嚴重程度則逐漸升高，顯示此評分系統亦適用於監測病況改善或惡化程度。為了瞭解新鮮冷凍血漿(fresh frozen plasma, FFP)於胰臟炎之治療效用，依據上述之評分系統將患貓進一步區分各種嚴重程度評估治療效果，第一級患貓(分數等於或小於12分者)，FFP Group與Control Group之死亡率皆為0%；第二級患貓(分數介於13-17分者)，FFP Group之死亡率為0%，Control Group之死亡率為33.3%；第三級患貓(分數介於18-30分者)，FFP Group之死亡率為88.9%，Control Group 之死亡率為100%；第四級患貓(分數等於或大於31分者)中，FFP Group及Control Group則死亡率皆為100%，顯示中等嚴重程度合併靜脈注射FFP有提升存活率之趨勢。總結，本研究所建立之嚴重程度評分系統可提供臨床醫師在初始積極之輸液復甦(fluid resuscitation)之後評估患貓狀況，分數隨時間之走向趨勢可以進一步用於評估預後。
並列摘要
Feline pancreatitis is the most common exocrine pancreatic disorder with varied mortality. There is no available and reliable method to evaluate the severity and prognosis of the disease. Fresh frozen plasma (FFP) has been reported to treat acute pancreatitis of cats. However, the efficacy has not been determined. Forty-three cats diagnosed as pancreatitis with acute onset of compatible clinical signs and a positive SNAP® fPLTM Test that hospitalized at NTUVH for therapy between October 2011 and September 2013 were enrolled in this study. All Cats were divided into survival (21/43, 48.8%) and non-survival (22/43, 51.2%) group. Hemoglobin, albumin, BUN, total bilirubin, phosphorous and systolic blood pressure were found to be significantly associated with disease severity and prognosis, and were selected for constructing the system. The severity scores in this study achieved an area under receiver operating characteristic (AUROC) of 0.978. The optimal cut-off point for discriminating outcome was 17.5 with the sensitivity of 95.2% and specificity of 95.5%, respectively. The mortality was 95.5% with a score ≥ 18, and 4.8 % with a score ≤ 17. In addition, the scoring system can be used to monitor disease progression. The increase in the scores indicate poor outcome. All cats were stratified into Level 1 (score ≤12), Level 2 (score range 12-17), Level 3 (score range 18-30) and Level 4 (score ≥ 31) by the severity scoring system. The cats treated with FFP and supportive care was grouped into FFP Group, whereas treated with only supportive care into Control Group. The mortality in Level 1 was 0% in both groups. The mortality in Level 2 was 0% in FFP Group and 33.3% in Control Group. The mortality in Level 3 was 88.9% in FFP Group and 100% in Control Group. None of cats in Level 4 survived. There was no significant difference between different treatment groups, however, the cats treated with FFP in moderate disease stage including Level 2 and 3 showed a trend of lower mortality. In conclusion, the severity scoring system of this study provides a reliable and clinical applicable method to predict clinical outcome in cats with pancreatitis. Treatment combined with FFP is advisable for clinical usage of feline pancreatitis.