本帖最后由 小柿子 于 2017-12-29 13:40 编辑
说来惭愧，我们医院去年到今年接了一家加菲猫舍多只猫瘟，无一幸免，全部over，还好主人比较信任我们，也知道这个病，没有说什么。但是我们心里也一直在想为什么，正好遇到帮友Brentchris发了篇关于猫细小病毒的文章，就问他有没有关于猫瘟治疗的文章，他发了我这篇文章，虽然是2010年发表的，但是觉得仍然有很大的指导价值，特翻译在此（注：时间有限，正文仅节选最后的讨论部分，如需全文，请@Brentchris。）另外，小伙伴们关于治疗猫瘟有哪些心得体会也请分享下，帮助我们破解猫瘟高死亡率，非常感谢。
Please read the English version first, then perhaps you can help me find some mistakes, thanks. 请先看英文，或许你可以帮我找出翻译错误，谢谢。
Prognostic Factors in Cats with Feline Panleukopenia 猫泛白细胞减少症的预后因素
B.D. Kruse, S. Unterer, K. Horlacher, C. Sauter-Louis, and K. Hartmann
Background: Feline panleukopenia is a highly contagious and often lethal disease. 背景：猫泛白细胞减少症是一种高传染性且常致命性的疾病。
Objective: The purpose of the study was to identify prognostic factors for survival of cats with panleukopenia. 目标：本研究的目的是找出影响泛白细胞减少症患猫预后的因素。
Animals: Between 1990 and 2007, 244 cats were diagnosed with panleukopenia in the Clinic of Small Animal Medicine, LMU University of Munich, Germany. Diagnosis was established by electron microscopy, polymerase chain reaction of feces or blood, antigen ELISA of feces, pathognomonic histopathological lesions at necropsy, or some combination of these procedures. 动物：1990到2007年之间，在德国慕尼黑大学小动物医学诊所共有244只猫诊断为泛白细胞减少症。诊断方法包括电子显微镜、粪便或血液聚合酶链反应、粪便抗原ELISA测试、 剖检时特殊的组织病理学特征或以上诊断方法联合使用。
Methods: Medical records of each cat were evaluated retrospectively. 方法：回顾分析每只猫的病历。
Results: Survival rate was 51.1%. No significant correlation was found between outcome and living conditions, age,vaccination status (unvaccinated versus one or more vaccines administered), or severity of clinical signs. However, of the vaccinated cats, none had received a vaccine later than 12 weeks of age as a kitten. Nonsurvivors had significantly lower leukocyte and thrombocyte counts at presentation compared with survivors. 结论：整体存活率是51.1%。没有发现存活率与以下因素有关：生活环境、年龄、免疫状态（未免疫或免疫过一次或多次）、临床症状的严重性。然而，在所有免疫过的猫中，没有一只处于幼龄阶段时在12周龄后接种过疫苗。死亡猫与存活猫相比白细胞和血小板显著降低。
The relative risk of death for patients with <1,000/mL leukocytes was 1.77 times as high as in patients with a leukocyte count of 1,000–2,500/mL (P 5 .038), and 1.85 times as high as in patients with >2,500/mL leukocytes (P 5 .001). The likelihood of a fatal outcome was higher when serum albumin concentration was <30 g/L or serum potassium concentration <4 mmol/L. 患猫白细胞<1,000/mL时死亡率比白细胞1,000–2,500/mL (P =.038)时高1.77倍，比>2,500/mL(P = .001)时高1.85倍。当血清白蛋白浓度<30 g/L 或血钾浓度<4 mmol/L时死亡率升高。
Conclusions and Clinical Importance: Vaccination strategies that do not include vaccination of kittens beyond 12 weeks of age may not be adequate to prevent panleukopenia. Leukopenia, thrombocytopenia, hypoalbuminemia, and hypokalemia are negative prognostic factors in cats with panleukopenia. 结论以及临床重要性：幼猫免疫程序如果在12周龄结束，12周龄后不再免疫，这可能不足以预防泛白细胞减少症。白细胞减少、血小板减少、低白蛋白和低血钾是猫泛白细胞减少症的不良预后因素。
Discussion 讨论 This study demonstrates that leukocyte and thrombocyte counts as well as serum albumin and potassium concentrations at presentation are prognostic indicators in cats with panleukopenia, whereas vaccination status, age, clinical signs, and housing conditions are not. 这项研究表明白细胞和血小板总数以及血清白蛋白和血钾浓度在就诊时可以作为猫泛白细胞减少症的预后指标，然而免疫状态、年龄、临床症状和家庭环境与预后关系不大。
The findings regarding signalment reported in this study are similar to those of previous studies of canine parvovirosis. Most affected cats were <1 year of age: median age was 4 months and 56.7% of the affected cats were <6 months of age. However, 25.3% were >1 year of age and 10.7% were >5 years of age. This finding is interesting in light of the perception that older cats are protected either by widespread vaccination or earlier subclinical infection. In 1 study, the prevalence of antibodies against FPV in young domestic cats from Costa Rica was 92.8%; only 16.5% of them were vaccinated previously. Reasons for the high infection rate in older cats in this study may include inadequate immunization and lack of virus exposure in the environment (eg, high percentage of indoor cats, resulting in a lower immunity). In contrast to Costa Rica, the present study was performed in Munich, a German city in which many cats are kept strictly indoors. 关于临床特征的发现与先前犬细小病毒的研究非常相似。大部分感染的猫<1岁：平均4月龄且56.7%<6月龄。然而，25.3%>1岁，10.7%>5岁。这一发现与一贯认为的年纪大的猫咪会被广泛的疫苗或者早先的亚临床感染保护的这一看法相左。先前一项研究表明，在来自Costa Rica的家养幼猫中FPV抗体的存在率达到92.8%，但是其中只有16.5%幼猫先前接种过疫苗。本研究发现的大龄猫咪高感染率可能与免疫力不足或环境中病毒暴露不足有关（例如室内猫占比高，导致低免疫力）。与Costa Rica不同，本研究是在慕尼黑进行的，在慕尼黑很多猫咪是被严格养在室内的。
A study from the United Kingdom reported that 25% of all kitten mortality was due to FPV. In CPV infection, the older the dog, the more favorable the prognosis. In this study, there was no significant correlation between age and severity of clinical signs and outcome. Based on this study, young cats are more susceptible to feline panleukopenia, but do not have an increased risk of death, which contradicts the idea that the highest morbidity and mortality occur in kittens up to 12 months of age. 英国的一项研究报道幼猫死亡25%的原因是由于FPV。CPV感染时，患犬年龄越大，预后越好。在本研究中，并没有发现年龄、临床症状的严重性和结果之间有什么重要关联。根据本研究，幼猫更易感猫泛白细胞减少症，但死亡率并不会上升，这与12月龄以下幼猫感染率和死亡率最高的观点不一致。
In this study, indoor cats were overrepresented compared with outdoor cats, and 14.5% had no contact with other cats indicating that indirect transmission is an important mode of infection. Transmission can occur via contaminated clothing, cages, and insect vectors. In this study, there was no significant difference in housing conditions (indoors versus outdoors) between unvaccinated cats and cats that were administered ≧1 vaccines. It can be assumed that natural contact with parvovirus is less likely in indoor cats, thus their chance to build protective immunity because of inapparent infection is decreased. 本研究中，室内猫数量明显超过室外猫数量，并且有14.5%室内猫从没接触过其他猫咪，这表明间接传播是一种重要的传染方式。污染的衣物、笼子和寄生虫可以间接传播。本研究中，未免疫猫和免疫≧1次猫的家庭环境（室内和室外）之间并没有显著差异。可以推理认为室内猫自然接触细小病毒的可能性更低，因此这些猫由于隐形感染而形成保护性免疫力的可能性也随之降低。
In this study, 39.7% of cats with panleukopenia had received 1 vaccines and despite this fact developed the disease. However, none of the cats that received vaccines would be considered to be completely vaccinated according to current guidelines, which advise administration of vaccines every 3–4 weeks from 6 weeks of age through at least 16 weeks of age. The lack of protective antibody titers in the face of vaccination may be because of interference with maternal antibodies, which can last up to 20 weeks of age. Lack of or incomplete vaccination is a significant risk factor for development of CPV enteritis. Additional reasons for an inadequate increase in protective antibody titers in this population might be vaccination of immunocompromised or subclinically infected patients, administration of less immunogenic inactivated vaccines, or infection with new parvovirus strains not neutralized by vaccine-induced protective antibodies. 本研究中，39.7%的泛白细胞减少症患猫曾经接种过1次疫苗，但是还是感染了。然而根据当前的免疫指导，这些打过疫苗的猫的免疫程序都不完整，当前的免疫指导建议幼猫6周龄开始免疫，且每隔3-4周再免一次直到最后一次免疫在16周龄或以上。免疫后仍缺乏保护性抗体滴度可能是因为母源抗体的干扰，母源抗体可能持续存在到20周龄。未免疫或免疫不全是CPV感染的非常重要的因素。其他造成这些猫保护性抗体滴度不足的原因可能是接种疫苗时免疫缺陷或亚临床感染，接种的灭活疫苗免疫原性差，或者感染了其他无法被疫苗产生的保护性抗体中和的细小毒株。
No significant association between vaccination status and outcome or duration of hospitalization could be identified. This is an unexpected finding because it was assumed that patients that received at least 1 vaccine would at least be more likely to recover if they developed the disease. In this retrospective study, however, there were no cats that would be considered to have been adequately vaccinated according to current guidelines. Therefore it is possible that vaccination based on current guidelines may result in better outcomes or less severe clinical signs in infected cats. 疫苗状态和预后或者住院时间之间没有发现明显的关联。这一发现有些出乎意料，因为大家一贯认为如果猫患病之前打过至少1针疫苗那么应该会更有可能治愈。然而，在本回顾性研究中，根据当前免疫指导，没有一只猫可以被认为是经过完全免疫的。因此，可以推理出如果按照当前免疫指导进行免疫那么结果会更好或者患猫的临床症状会减轻。
In this study, 69.3% of patients had diarrhea and 62.7% had vomiting. However, 30.7% never developed diarrhea and 37.3% never had vomiting. Some of these cats may have had a peracute form of the disease and died before gastrointestinal signs occurred. However, 10.2% never developed diarrhea or vomiting despite a prolonged course of illness and 54.2% had a favorable outcome. Interestingly, 34.2% of the cats never developed leukopenia during the course of their disease, and 15 patients had neither gastrointestinal signs nor leukopenia. In these cats, a parvovirus infection was suspected either because of known contact with a cat with FPV or the disease was diagnosed at necropsy. Cats with normal or increased leukocyte counts may have had leukopenia before testing or alternatively may have been tested before leukopenia occurred. A peracute infection also could have been present in these cats. Although cats were excluded if vaccinated against panleukopenia in the 3 weeks before admission, a vaccine-induced false-positive result for FPV cannot be totally excluded in cats with unknown vaccination history that were not diagnosed at necropsy. 本研究中，69.3%患猫腹泻，62.7%呕吐。然而，30.7%从未腹泻，37.3%从未呕吐。一些猫可能是超急性发病，胃肠道症状还没有表现出来便已死亡。然而，10.2%患猫病程很长但是却从未腹泻或者呕吐，且其中54.2%预后良好。有趣的是，34.2%的猫在患病过程中白细胞一直未减少，15只猫既没有胃肠道症状也没有出现白细胞减少。这些猫被怀疑细小病毒感染是因为与患FPV的猫接触过或者在尸检时确诊。白细胞正常或升高的猫可能在检测之前出现白细胞减少或者是在出现白细胞减少之前检测的。也有可能在这些猫中发生了超急性感染。虽然患病前3周接种过猫瘟疫苗的猫咪都被排除了，但是仍无法保证完全没有FPV假阳性的影响，因为有些猫的免疫史不清且尸检时未确诊。
Bloody diarrhea may develop as consequence of severe enteritis with serious mucosal damage, DIC, or coinfections with other organisms. In CPV infections, giardiasis exacerbates the clinical syndrome. In kittens, coexisting salmonellosis has been reported. Hemorrhagic diarrhea, a typical sign of CPV enteritis, was only present in 14.1% of our cats. Canine intestinal crypts may be more susceptible to viral destruction and serious mucosal damage compared with feline enterocytes. Potentially, local intestinal immune defense (eg, Peyer’s patches) may be more effective in cats than in dogs. 血便可能继发于严重肠炎伴随严重黏膜损伤、DIC或同时感染其他微生物。在CPV感染中，贾第鞭毛虫可以加重临床症状。在幼猫中有报道发现并发沙门氏菌感染。血便，CPV肠炎的典型症状，只出现于我们14.1%的猫中。相较于猫肠细胞，犬肠隐窝更加容易受到病毒的破坏造成严重黏膜损伤。很可能，猫的局部肠道免疫力（例如Peyer淋巴结）比犬更强。
Interestingly, in this study, no clinical sign was significantly related to outcome as described in dogs. However, previous studies have identified clinical predictors for lethal outcome in dogs and cats (eg, presence of SIRS, sepsis, and hypothermia). 有趣的是，本研究中，没有哪一项临床症状与预后有明显关联，不像犬那样，临床症状对预后有指示作用。然而，先前的研究也证实了一些犬猫预后不良的临床指示（例如SIRS、败血症和低温）。
FPV and CPV infection lead to bone marrow suppression typically resulting in leukopenia. This study confirms that severity of leukopenia parallels that of clinical illness and risk of death, similar to results of previous studies in dogs. In most dogs, neutrophil nadir and most severe clinical illness occur concurrently. Presumably death of cats also would occur during this severe state of clinical illness and neutrophil nadir. Experimental infections of cats using CPV-2b caused only slight leukopenia but marked lymphopenia, similar to CPV infection in dogs.27 Of 137 cats, 38.7% had lymphopenia. In contrast to total leukopenia, lymphopenia was not associated with disease outcome. Lymphopenia with concomitant neutropenia was observed more often than solitary lymphopenia (27.7% versus 11.0%). Possibly, some cats of this study were infected with CPV rather than with FPV. Ideally, it should have been investigated whether CPV instead of FPV was the infectious agent in some cases. However, samples from the cats were no longer available. FPV和CPV感染会导致骨髓抑制，引起典型的白细胞减少。跟先前的犬研究一样，本研究确认了白细胞减少的程度与临床兵器和死亡风险相一致。大部分的犬，中性粒细胞最低点和病情最重同时发生。据此推测猫病情最重和中性粒细胞最低点也会同时发生。用CPV-2b感染猫进行实验时发现只引起轻微的白细胞减少但是显著的淋巴细胞减少，与犬CPV感染相似。137只猫中27只，38.7%出现淋巴细胞减少。与白血病减少不同，淋巴细胞减少与疾病的预后没有关联。淋巴细胞减少同时白血病减少比单独淋巴细胞减少更常见（27.7%比11.0%）。有可能，本研究中一些猫感染的是CPV而不是FPV。如果某些病例能进一步研究确认病原是CPV还是FPV那就更好了，但是，无法获得这些猫的样本了。
In this study, the 2nd most commonly observed hematologic abnormality, exclusive of leukopenia, was thrombocytopenia attributed to megakaryocyte destruction or increased consumption caused by DIC. DIC generally is associated with a high case fatality rate. In most cats, thrombocytopenia was not prominent (median in survivors, 260,000/mL; median in nonsurvivors, 195,000/mL at presentation). However, a lower thrombocyte count was significantly correlated with negative outcome. This finding is in contrast to a study of dogs with CPV that found no significant association between thrombocytopenia and outcome. Furthermore, in a study of hypercoagulability in dogs with CPV, all dogs had hypercoagulability, but none had measurable DDimers or thrombocytopenia. A low thrombocyte count also may reflect severity and more advanced stage of disease because of severe viral megakaryocyte destruction, and thus may explain its role as a negative prognostic factor as detected in the present study. Additional studies would be necessary to investigate if parvovirus has more cell tropism for megakaryocytes in cats compared with dogs or if cats have a higher risk for developing DIC in severe systemic infectious diseases compared with dogs. 本研究中，第2大常见的血液学异常，除了淋巴细胞减少，是血小板减少，由巨核细胞被破坏或DIC引起的大量消耗造成。DIC通常代表着高死亡率。大部分的猫，血小板减少不明显（就诊时存活者的平均值260,000/mL，死亡者的平均值195,000/mL）。然而，血小板总数减少与预后不良有明显关联。这一发现与犬相反，犬CPV研究发现血小板减少与预后之间没有明显联系。而且，在一项关于犬CPV高凝状态的研究中发现所有的犬血液呈高凝状态，但是没有一只能检测出D-Dimers值或血小板值。低血小板总数可能反应病情的严重性，表明严重的病毒性巨核细胞破坏使疾病进一步恶化，这可能用来解释本研究发现的其作为不良预后因素的原因。需要进行更多的研究来发现细小病毒在猫体内是否比在犬体内对巨核细胞有更大的倾向性，或者说猫比犬在患系统性感染性疾病时更容易发生DIC。
In this study, anemia was not associated with negative outcome, an unexpected finding considering that gastrointestinal blood loss, coinfections (4.8% of cats were infected with FeLV), serious bone marrow suppression, or sepsis-associated anemia of inflammatory disease represent severe and serious complicating factors. Because of the relatively long life span of erythrocytes, marked anemia is less common in CPV and FPV, unless intestinal blood loss is severe, but nonregenerative anemia can be seen with FPV infection. Mild anemia may have been masked by severe dehydration in this study. 本研究中，贫血与预后不良没有关系，意料之外的发现，因为胃肠道失血、并发感染（4.8%的猫感染了FeLV）、严重骨髓抑制或败血症相关贫血代表着严重的并发症。由于红细胞相对较长的生存期，CPV和FPV少见显著的贫血，除非有严重的肠道出血，但是FPV感染时可见非再生性贫血。本研究中轻微贫血也可能会被严重脱水掩盖。
Hypoalbuminemia was the most frequent biochemical abnormality, resulting from decreased protein intake and leakage into the gastrointestinal tract because of severe mucosal lesions. In dogs, hypoalbuminemia (<20 g/L) represents a risk factor for negative outcome in enteropathies. Serum albumin concentration <30 g/L at presentation was associated with a negative outcome in this population of cats, and can be explained by the association between hypoalbuminemia and decreased plasma colloid osmotic pressure, which diminishes effective perfusion at the capillary level, possibly leading to DIC, organ failure, and death. 低白蛋白血症是最常见的生化异常，由于蛋白质摄入减少和严重的粘膜损伤造成的胃肠道蛋白质流失引起。犬肠病时低白蛋白血症（<20 g/L）是预后不良因素之一。本研究的猫中发现，血清白蛋白浓度<30 g/L与不良预后相关，这可能是由于低白蛋白造成的血浆胶体渗透压降低，进而造成毛细血管有效灌注减少，可能会导致DIC、器官衰竭和死亡。
A serum potassium concentration <4 mmol/L at presentation was associated with negative outcome. On the contrary, low serum potassium concentration is not associated with outcome in CPV infection. However, dogs with CPV had significantly lower serum concentrations of potassium than did controls in another study. Hypokalemia can be explained by anorexia, vomiting, increased gastrointestinal potassium losses, fluid therapy, or possible refeeding syndrome, and most likely reflects the severity of the enteritis. 就诊时血清钾离子浓度 <4 mmol/L与不良预后有关。相反，CPV感染时低血钾浓度与预后没有关系。然而，另一项研究发现与控制组相比CPV患犬血钾浓度显著降低。低血钾症可能是由于厌食、呕吐、胃肠道钾大量流失、输液或者再饲喂综合症，并且很大可能反应肠炎的严重程度。
（下面讲了些这个研究的一些限制方面。这句话很有趣： Because most patients were treated with a very similar treatment protocol, an effect of therapy on disease outcome could not be evaluated. 因为大部分病猫是按照相似的治疗原则进行治疗，所以无法评估治疗方案对疾病预后的影响。 想知道他们的相似的治疗原则是哪些原则，有人知道吗......)
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发表于 2017-12-29 11:34:10
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