在患有中耳炎的犬，健康的犬还有患有慢性外耳炎的犬血浆C反应蛋 ...

王帆

Evaluation of plasma canine C-reactive protein concentrations in dogs with otitis media, healthy dogs and dogs with chronic otitis externa

在患有中耳炎的犬，健康的犬还有患有慢性外耳炎的犬血浆C反应蛋白浓度评价

 

翻译：李美；校对：王帆

 

Abstract：

摘要：

Background:Otitis is characterised by inflammation of one or more of the structures of the ear. At present, to confirm or exclude otitis media (OM), it is most often necessary to perform a computed tomography (CT) scan or magnetic resonance imaging. Inflammation is an immune defence response found in many conditions that can be detected and tracked by measuring biological markers of inflammation as the Canine C-reactive protein (CRP).

背景：耳炎的特征是耳部的一个或多个结构的炎症。目前，为了确认或排除中耳炎（OM），通常需要进行计算机断层扫描（CT）扫描或磁共振成像。炎症是一种免疫防御反应，可在许多疾病中发现，可以通过测量炎症的生物标志物，如犬c反应蛋白（CRP）来检测和跟踪。

Objectives: The objective of this study was to determine whether CRP measurement is useful as an adjunctive diagnostic tool in dogs with otitis and whether elevated concentrations correlated with disease severity/presence of OM.

目的：本研究的目的是确定CRP测量是否可作为犬耳炎的辅助诊断工具，以及浓度升高是否与疾病的严重程度/中耳炎（OM）的存在相关。

Animals: Twenty-four client-owned dogs were recruited over 1 year.

动物：在1年的时间内招募了24只家养犬。

Materials and Methods: The dogs were divided into three groups: chronic or recurrent otitis externa (CO), otitis media (OM) and H (healthy). The dogs with otitis underwent a CT scan of the head, measurement of the plasma CRP concentration and evaluation of a 0–3 Otitis Index Score 3 (OTIS3 score).

材料与方法：将犬分为慢性或复发性外耳炎（CO）、中耳炎（OM）和H（健康）三组。对耳炎患犬进行头部CT扫描，测量血浆CRP浓度，并评价0-3分耳炎指数评分3（OTIS3评分）。

Results: No dog (0%) in group H had an increased CRP value, compared to 20% in the CO group (one of five dogs) and 23% in the OM group (3 of 13 dogs). Plasma CRP concentrations show a statistically significant positive relationship with the OTIS3 score (p=0.04).

结果：H组无犬（0%）CRP值增加，CO组为20%（5只中1只），OM组为23%（13只中的3只）。血浆CRP浓度与OTIS3评分呈有统计学意义的正相关（p=0.04）。

Conclusion and Clinical Relevance: Plasma CRP concentration is not reliable as a discriminatory tool in cases of otitis, although there is a trend for elevation in cases with more severe disease. However, a larger study may provide a statistically more reliable correlation between the severity of OM and CRP concentrations.

结论和临床意义：血浆CRP浓度作为耳炎病例的鉴别工具并不可靠，但在病情较严重的病例中有升高的趋势。然而，更大的研究可能提供OM和CRP浓度之间统计学上更可靠的相关性。

 

KEYWORDS

关键词

canine C-reactive protein, OTIS3 score, otitis, otitis media

犬c反应蛋白，OTIS3评分，耳炎，中耳炎

 

INTRODUCTION

介绍

Otitis is characterised by inflammation of one of the structures of the ear: otitis externa (OE) in case of inflammation of the external canal, otitis media (OM) in case of inflammation of the tympanic membrane and the tympanic bulla, and otitis interna (OI) when the inner ear is affected.

耳炎的特征是耳结构的炎症：外耳炎（OE）是外耳道炎症，中耳炎（OM）是鼓膜和鼓泡炎症时，内耳炎（OI）是内耳患病。

 

These conditions are very common and sometimes progress with minimal or no clinical signs. In case of acute or chronic OE, clinical signs do not always indicate the presence or absence of OM.

这些疾病非常常见，有时进展得很小或没有临床症状。在急性或慢性OE病例中，临床症状并不总是表明存在或不存在OM。

 

Conventional radiographic examination can be used to obtain images compatible with OM (opacity indicating soft tissue or fluid in the tympanic bulla and/or thickening or lysis of the wall of the tympanic bulla). However, this diagnostic modality is not very sensitive, with between 25% and 40% false negatives, depending on the study.At present, to confirm or exclude OM, it is most often necessary to perform a computed tomography (CT) scan or magnetic resonance imaging (MRI).These diagnostic modalities require general anaesthesia, expensive equipment and expose the animal to a non-negligible amount of X-rays during the CT scan, which may limit employment of these diagnostic tools.

常规的影像学检查可用于获得与OM兼容的图像（鼓泡内不透明提示有软组织或液体和/或鼓泡壁增厚或溶解）。然而，这种诊断方式并不敏感，根据研究的不同，有25%到40%为假阴性。目前为了确认或排除OM，通常需要进行计算机断层扫描（CT）或磁共振成像（MRI）。这些诊断方法需要全身麻醉、昂贵的设备，并在CT扫描期间将动物暴露在不可忽视的X射线中，这可能会限制这些诊断工具的使用。

 

Inflammation is an immune defence response seen in many conditions that can be detected and monitored by measuring biological markers of inflammation. A good marker is ideally one where the concentration increases in the initial phase of the inflammatory process and has a short half-life, allowing for accurate reflection of the inflammatory process and resolution. The increase in the marker should depend solely on the inflammatory response and should be significant compared to its normal plasma concentration. There are many markers of inflammation, with varying degrees of sensitivity and kinetics, which make it possible to detect an inflammatory syndrome and monitor its progression as well as the effectiveness of treatments.

炎症是一种免疫防御反应，见于许多情况下，可以通过测量炎症的生物标志物来检测和监测。理想情况下，一个好的标记是浓度在炎症过程的初始阶段增加，半衰期较短，允许准确反映炎症过程和恢复。该标记物的增加应仅取决于炎症反应，与正常血浆浓度相比应显著。有许多炎症标志物，具有不同程度的敏感性和动力学，这使得检测炎症综合征和监测其进展以及治疗的有效性成为可能。

 

Canine C-reactive protein (CRP) is a protein representative of the acute phase of inflammation that is secreted as a result of tissue damage (sterile, infectious or neoplastic process) or postsurgery. It is an early and sensitive marker of an acute systemic inflammatory response in dogs. The increase in blood concentration occurs 5–6 h after the onset of the inflammatory process. The half-life is 18 h, and CRP reaches its maximum concentration within 2 days after the beginning of the initial inflammatory process, in experimental conditions. It can drop in <6 h once the inflammatory process has been resolved.Measurement of CRP concentration is used to monitor the progression of multiple internal diseases in dogs such as infectious processes (pyometra, peritonitis, babesiosis) and inflammatory diseases (polyarthritis, glomerulonephritis, pancreatitis, enteritis, meningoencephalomyelitis).

犬c反应蛋白（CRP）是一种代表炎症急性期的蛋白质，由组织损伤（无菌、感染或肿瘤过程）或术后分泌。它是犬的急性全身炎症反应的早期和敏感的标志物。血液浓度增加发生在炎症过程开始后5-6小时。在实验条件下，半衰期为18 h，CRP在初始炎症过程开始后2天内达到最大浓度。一旦炎症过程得到解决，6小时内就会下降。CRP浓度的测量用于监测犬的多种内科疾病的进展，如感染过程（子宫积脓、腹膜炎、巴贝斯虫病）和炎症性疾病（多性关节炎、肾小球肾炎、胰腺炎、肠炎、脑膜脑脊髓炎）。

 

The main objective of the study was to determine whether the measurement of CRP is a useful guidance tool (i) to support the diagnosis of OM and (ii) for assessment of severity, in cases of canine OM.

该研究的主要目的是确定CRP的测量是否是一个有用的指导工具(i)支持OM的诊断和（ii）评估犬OM病例的严重程度。

 

MATERIALS AND METHODS Recruitment and ethics

材料和方法 招募和行为准则

Client-owned dogs, weighing >2 kg and <50 kg, >6 months of age and <10 years of age, of any breeds and sex were recruited. Affected animals were recruited with clinical signs of OE (ear scratching, pinnal erythema, otic discharge, swelling of the ear canals), and when the clinician had requested a CT scan of the tympanic bullae owing to the chronicity of the OE, or the presence of neurological signs referable to OM/OI.

家养犬，体重>2公斤到<50公斤，年龄>6月龄到<10岁，任何品种和性别都被招募。患病动物需要有OE的临床症状（抓挠耳部、耳廓发红、耳分泌物、耳道肿胀），以及临床医生因慢性OE要求进行鼓泡CT扫描，或存在与OM/OI相关的神经症状。

 

Healthy control dogs were enrolled in the study, recruited from the preventive medicine department, without any history of dermatological or otic disease and with a normal clinical examination.

健康对照组的犬被纳入研究，从预防内科招募，无任何皮肤病或耳部病史，临床检查正常。

 

The recruitment was performend in two sites [veterinary clinics in Saint-Julien-en-Genevois ((Haute-Savoie, France) and Saint-Priest (Rhone, France)] over a 12-month period.

招募工作在圣朱利安的两个兽医诊所进行（法国上萨瓦）和圣牧师（法国罗纳）），为期12个月。

 

A ‘Consent form’ and documents detailing the clinical study were given and signed by the owners of all recruited dogs (affected and nonaffected dogs). Each medical procedure carried out on the recruited animals was carried out in the same way as part of routine medical care.

所有被招募的犬（患病和未患病犬）的主人都提供并签署了一份“同意书”和详细说明临床研究的文件。对招募的动物进行的每项医疗程序都以常规医疗护理的方式进行。

 

Inclusion visit

纳入就诊

• The recruited dogs did not receive any treatment in the 2weeks before the inclusion visit (Day 0).

• 被招募的犬在纳入就诊前2周（第0天）没有接受任何治疗。

• The healthy dogs underwent a physical, a conscious video-otoscopic examination (c-Mac; Karl Storz) 0–3 Otitis Index Scores 3 (OTIS3 score) and a plasma CRP measurement as part of a routine health blood test. Cytological evaluation was deemed unnecessary as the ears were normal and a CT scan was not performed owing to ethical considerations.

• 健康的犬接受了体格检查、有意识的视频耳镜检查进行0-3耳炎指数评分3（OTIS3评分）和血浆CRP测量，作为常规健康血液测试的一部分。细胞学评估被认为是不必要的，因为耳部是正常的，没有进行CT扫描。

• For each dog with otitis, a thorough anamnesis was recorded to determine the chronic and recurrent nature of the otitis and to detect possible concurrent diseases. These dogs underwent a general anaesthetic and video-otoscopic examination. The OTIS3 score was recorded at the initial visit with a score>4 consistent with otitis. For dogs with bilateral otitis, the retained score was the higher of the scores from each ear.

• 对于每只耳炎患犬，详细记录既往病史，以确定耳炎的慢性和复发性质，并发现可能的并发病。这些犬接受了全身麻醉和视频耳镜检查。首次就诊时记录OTIS3评分，>4评分与耳炎一致。对于双侧患有耳炎的犬，保留的得分较高。

• Cytological evaluation of the discharge present in the external ear canal was performed for each affected ear, introducing a swab into the vertical ear canal, and rolling it on a slide on a single layer. The slide was immediately coloured with a modified Wright's stain (RAL 555 kit), dipping it eight times in each colourant and was read with a Leika microscope at ×100 magnification, to determine the presence of neutrophils and microbial agents. In case of the presence of bacteria, a culture was performed.

• 对每个患耳的外耳道内的分泌物进行细胞学评估，将拭子引入垂直耳道，并将其在单层的载玻片上滚动。立即用改良的Wright染色剂（RAL 555试剂盒）对载玻片进行着色，在每种染色剂中浸泡8次，然后用×100放大的莱卡显微镜读取，以确定存在中性粒细胞和微生物。如果存在细菌，则进行培养。

• The presence of neurological signs referrable to middle/inner ear disease such as vestibular syndrome, nystagmus or facial paralysis was recorded at the initial examination.

• 在首诊时，记录了中耳/内耳疾病导致的神经系统症状，如前庭综合征、眼球震颤或面瘫。

• A CT scan was performed on all the dogs affected with otitis. The CT scans were read by diplomates specialising in imaging (VeDim; Veterinary Teleradiology). Otitis media was diagnosed when bone lysis or thickening of the bullae wall and/or soft tissue or fluid opacity in the tympanic bulla was observed.

•对所有耳炎患犬均进行了CT扫描。CT扫描结果由成像专业的文凭阅读（VeDim；兽医远程放射学）。当观察到鼓泡壁的骨溶解或增厚和/或鼓泡内的软组织或液体混浊时，就被诊断为中耳炎。

• A blood sample was collected from all of the affected and nonaffected dogs into heparinised tubes. Plasma was separated by centrifugation at 1700g for 6min and kept at 20°C until analysis. Plasma CRP concentration was determined using the automatic analyser IDEXX Catalyst on sites, within 5min of the blood draw. IDEXX Catalyst includes a new ‘sandwich’-type enzyme immunoassay with gold nanoparticles designed to measure canine CRP in samples of heparinised plasma (heparin with lithium) or serum. The normal range is 0.1–10.0mg/dL (SI units: 1.0–100.0mg/L). CRP concentration was considered to be elevated when it was >10mg/L, based on the manufacturer's data sheet and another report.

•所有患病和未患病犬进行采血保存至肝素管中。血浆经1700g离心6 min分离，20 C保存至分析。使用自动分析仪IDEXX催化剂在抽血后5 min范围内测定血浆CRP浓度。IDEXX催化剂包括一种新的“三明治”型酶免疫分析法，用金纳米颗粒设计，用于测量肝素化血浆（肝素与锂）或血清样本中的犬CRP。正常范围为0.1–10.0mg/dL（SI单位：1.0–100.0mg/L）。根据制造商的数据表和另一份报告，当CRP浓度>10mg/L时，我们认为CRP浓度会升高。

 

In cases where elevated CRP concentration was detected, screening for a possible concurrent disease was carried out, based on various clinical and paraclinical examinations: rectal temperature, urinalysis, complete blood count, baseline biochemical work, albumin and total calcium measurement (determined using the automatic analysers IDEXX Catalyst and IDEXX Procyte on sites).

在检测到CRP浓度升高的病例，根据各种临床和临床旁检查：直肠温度、尿检、全血计数、基线生化工作、IDEXX白蛋白和总钙测量（使用自动分析仪测定）进行筛查。

 

A ‘Treatment and tolerance follow-up’ document was distributed to all of the affected dogs' owners. This was completed daily, recording treatments, dose and time of administration.

一份“治疗和耐受性随访”文件被分发给了所有患犬的主人。这是每天完成的，记录治疗、剂量和给药时间。

 

Treatment of dogs with CO and OM

用CO和OM治疗犬

Medical management for the affected dogs was instituted based on clinical signs, results of cytological evaluation, culture and presence/absence of OM. Anti-inflammatory treatment and pain relief were prescribed as indicated.

根据临床症状、细胞学评估结果、培养和是否存在OM，对患犬进行医疗管理。抗炎治疗和缓解疼痛。

 

Exclusion criteria

淘汰标准

Any dogs with one or more concurrent inflammatory/neoplastic diseases listed in Table 1, diagnosed before the inclusion visit or during the study, were excluded.

表1中列出的在纳入就诊前或研究期间诊断的一种或同时患有一种或多种炎症/肿瘤疾病的犬均被排除。

 

 

 

 

TABLE 1 Conditions that increase CRP (exclusion criteria).

表1：CRP升高的疾病（排除标准）。

Process 过程	Condition 疾病	Usual additional examination 通常的额外检查
Infection 感染	Pyometra子宫积脓 Babesiosis 巴贝西虫病 Leishmaniasis利什曼病 Leptospirosis钩端螺旋体病 Parvovirosis细小病毒病 Pneumonia肺炎 Bordetella bronchiseptica支气管败血性波氏杆菌  infection传染病 Escherichia 埃希氏菌 coli enterotoxaemia大肠杆菌肠毒素血症 Bacterial enteritis 细菌性肠炎 Peritonitis腹膜炎 Demodex 蠕形螨	Abdominal ultrasound腹部超声 Blood smear, 血涂片 CBC血常规 Serological investigation血清学检查 Rapid test,快速测试版  blood biochemical investigation血液生化检查 CBC, 血常规 rapid test快速测试版 Radiography X线检查 Clinical临床理学检查 Clinical临床理学检查 Clinical临床理学检查 Abdominal ultrasound腹部超声 Scraping,刮片检查 hair removal拔毛检查
Inflammation 炎症	Pancreatitis胰腺炎 Glomerulonephritis肾小球肾炎 Intestinal inflammationIntestinal 细菌性肠炎 obstruction异物梗阻 Gastric lesions胃部疾病 Surgery外伤 Degenerative valve disease退行性瓣膜病变 Degenerative arthritis关节炎 Autoimmune haemolytic anaemia自身免疫性溶血性贫血	cPL,胰腺炎快速测试版 abdominal ultrasound腹部超声 Blood biochemical investigation,血液生化检查 abdominal ultrasound腹部超声 Abdominal ultrasound X-ray腹部超声X线 Gastroscopy胃内镜检查 From memory外伤病史 Echocardiography心脏超声   X-ray,X线 synovial puncture滑膜穿刺     CBC血常规
Endocrine disorder 内分泌疾病	Cushing's syndrome库欣综合征 Diabetes糖尿病	ACTH stimulation test,ACTH刺激试验 blood biochemical investigation血液生化检查 Blood biochemical investigation血液生化检查
Liver problems 肝脏疾病	Congenital portosystemic shunt先天性门体分流 Chronic hepatitis慢性肝炎 Dissecting lobular hepatitisHepatic abscess肝小叶性肝脓肿 Cholangitis胆管炎	Blood biochemical investigation, 血液生化检查 abdominal ultrasound腹部超声 Abdominal ultrasound腹部超声
Neoplasia 肿瘤	Lymphoma淋巴瘤 Carcinoma癌症 Sarcoma肉瘤	Abdominal ultrasound,腹部超声 extended assessment进一步评估

 

Statistical analysis

统计分析

The relationship between the CRP concentrations and the OTIS score was tested with a linear regression. The proportion of dogs with OM and abnormal CRP was reported with its 95% confidence interval (CI; 8.2%–50.3%). The confidence interval was computed following Wilson's method, with the software R 3.6.3. For the purpose of the analysis, the OTIS score was considered a continuous variable. Regression assumptions were assessed with the method of global validation of linear model assumptions.

CRP浓度与OTIS评分之间的关系采用线性回归检验。OM和CRP异常的比例为95%置信区间（CI；8.2%–50.3%）。置信区间采用Wilson方法计算，软件R 3.6.3。为了进行分析，OTIS评分被认为是一个连续变量。回归假设采用线性模型假设的全局验证方法评估回归假设。

 

RESULTS

结果

Twenty-four dogs were recruited subsequent to the initial evaluation and imaging and divided into three groups:

在最初的评估和成像后，我们招募了24只犬，并将其分为三组：

• H (healthy control group): dogs without any clinical signs, n=6.

•H（健康对照组）：无任何临床症状的犬，n=6。

• CO (chronic OE): dogs with clinical signs of OE and a normal CT scan, n=5.

•CO（慢性OE）：有OE临床症状和CT扫描正常的犬，n=5。

• OM: dogs with OE and OM, n=13.

•OM：带有OE和OM的犬，n=13。

 

The additional clinical and paraclinical examinations carried out during the inclusion visit are summarised in

在纳入访问期间进行的额外的临床和临床旁检查总结在

 

Table 2. Results are reported in Table 3.

表2.试验结果报告见表3。

 

 

Signalment

特征

The mean age of the dogs was 5.68 years (range 10 months to 11 years), which varied by group: H, 4.5 years (1–9 years); CO, 6.2 years (1–9 years) and OM, 6 years (1–10 years). Thirteen breeds were represented and the breeds most represented in our population, especially in the CO and OM groups, were French bulldogs (37.5%) and cocker spaniels (8%). French bulldogs were over-represented compared with 5% at the general practice Hutins veterinary clinic (Haute-Savoie, France) and 7.9% in the OnlyVet hospital's clientele (Rhone, France). Cocker spaniels also were over-represented in our study compared to the representation rate of 1.1% at the Hutins veterinary clinic and 2.2% at the OnlyVet hospital. The distribution of the most represented breeds is summarised in Table 4.

犬的平均年龄为5.68岁（范围10个月至11岁），各组发生变化：H，4.5岁（1-9岁）；CO年龄6.2岁（1-9岁），OM年龄6岁（1-10岁）。共有13个品种的犬种，其中法国斗牛犬（37.5%）和可卡犬（8%）。法国斗牛犬的比例过高，而全科哈廷兽医诊所（法国上萨瓦）为5%，OnlyVet医院的客户（法国罗纳）为7.9%。与Hutins兽医诊所的1.1%和OnlyVet医院的2.2%相比，可卡犬的比例为2.2%。表4总结了最具代表性的品种的分布情况。

 

CRP in the CO and OM groups

在CO组和OM组中的CRP

No dog (0%) in the H group had an increased CRP value >10mg/L, compared to 20% in the CO group (one in five dogs) and 23% in the OM group (3 in 13 dogs). For 23.1% of dogs with OM, the CRP was >10mg/L (95% CI: 8.2%, 50.3%; Figure 1).

H组中没有一只犬（0%）的CRP值>增加了10mg/L，而CO组为20%（1/5），OM组为23%（13只犬中有3只）。对于23.1%的OM犬，CRP为>10mg/L（95% CI： 8.2%，50.3%；图1）。

 

OTIS3 score

OTIS3分数

The mean OTIS3 score for the CO group was 7.4 (5–9), and for the OM group was 5.3 (1–11).

CO组的平均OTIS3得分为7.4分（5-9分），OM组为5.3分（1-11分）。

 

CRP concentrations show a statistically significant positive relationship with the OTIS3 score (p=0.04).

CRP浓度与OTIS3评分呈有统计学意义的正相关（p=0.04）。

 

The mean increase in OTIS score for each increase in CRP of 1 unit was 0.17. The global validation of linear model assumptions did not detect any significant failure to meet the linear regression assumptions (Figure 2).

CRP每增加1个单位，OTIS评分平均增加0.17。线性模型假设的全局验证没有发现任何满足线性回归假设的显著失败（图2）。

 

Criteria of severity

严重程度标准

Calcification of the ear canal, osteitis of the tympanic bulla, neurological signs and suppurative otitis are considered to be criteria of severity. The average OTIS3 score for the CO group was 7.4 (5–9) and that for the OM group was 5.3 (1–11).

耳道钙化、鼓泡骨炎、神经系统症状和化脓性耳炎被认为是严重程度的标准。CO组的OTIS3平均评分为7.4分（5-9），OM组为5.3分（1-11）。

 

In the CO group, two dogs had suppurative OE and one dog had calcification of the external ear canal. In the OM group, five dogs had suppurative otitis, four dogs had calcification of the external ear canal and four dogs had osteitis of the tympanic bulla. Three dogs (CN20, CN22 and CN23) each presented at least two of these criteria of severity. CN06 had severe osteitis and osteolysis compatible with a tympanokeratoma, confirmed later by a TECABO.

在CO组中，有2只犬出现化脓性OE，1只犬出现外耳道钙化。在OM组中，化脓性耳炎5只，外耳道钙化4只，鼓泡骨炎4只。3只犬（CN20、CN22和CN23）各表现出至少两种这样的严重程度标准。CN06患有严重的骨炎和骨溶解症，与鼓室角化瘤相兼容，后来被TECABO证实。

 

DISCUSSION

讨论

CRP measurement

CRP测量

The results of our study show that the measurement of CRP is not a reliable supportive tool in the diagnosis of canine OM and cannot be used to discriminate between chronic OE and OM. However, there was a statistically positive correlation between the severity of otitis and plasma CRP concentrations. These findings may reflect the localisation of disease.

我们的研究结果表明，CRP的测量并不是诊断犬OM的可靠支持工具，不能用于区分慢性OE和OM。然而，耳炎的严重程度与血浆CRP浓度呈统计学正相关。这些发现可能反映了疾病的定位。

 

In the case of dog CN06 with a tympanokeratoma, the CT scan showed an opacity in the tympanic bulla, thickening of the walls, and marked signs of osteolysis. While it was expected that a severe local inflammatory process would increase the CRP value, the CRP value in this case was within the normal range. This can be explained by the fact that the inflammatory phenomenon is sufficiently localised so as not to cause an increase in the CRP value.

在犬CN06伴鼓室角化瘤的病例中，CT扫描显示鼓泡不透明，鼓壁增厚，并有明显的骨溶解征象。虽然预计严重的局部炎症过程会增加CRP值，但本例中的CRP值在正常范围内。这可以用炎症现象具有足够的局限性的事实来解释，因此不会导致CRP值的增加。

 

By contrast, dog CN24 was suffering from chronic erythematous OE with Malassezia, without clinical signs of severity, a bilateral OTIS3 score of 7 and the CRP value was increased to 24.1mg/L. Because Malassezia erythematous OE does not cause general inflammatory phenomena, the increased value of CRP may be explained by the localised inflammation of the ear canal.

相比之下，犬CN24患有慢性红斑性OE伴马拉色菌，无严重程度的临床症状，双侧OTIS3评分为7分，CRP值升高至24.1mg/L。由于马拉色菌红斑性OE不会引起一般的炎症现象，CRP值的增加可能是由于耳道的局部炎症。

 

These two examples illustrate the low probability of correlation between the CRP value and the diagnosis of OM.

这两个例子说明了CRP值与OM诊断之间的相关性概率较低。

 

Over-representation of French bulldogs

法国斗牛犬的高发病率

The population assessed in this study confirms the over-representation of the French bulldog breed in OM cases, a result observed in previous studies.

本研究中评估的种群证实了法国斗牛犬品种的高发病率，这是在以前的研究中观察到的结果。

 

In the study by Love et al., the most represented breed was cocker spaniel. The 1995 Livre des Origines Françaises (LOF) statistics gives 606 French bulldogs and 2808 cocker spaniels registered versus 5911 and 6604 (respectively) in 2021.17 French bulldogs have significantly increased in popularity since the early 2000s, with an 875% increase in numbers between 2000 and 2021, compared with a 135% increase for the cocker spaniel. The popularity of the brachycephalic morphotype has resulted in genetic selection for certain diseases such as atopic dermatitis, anatomical conformation defects of the ear canal in this breed and predisposition to OE/OM.

在Love等人的研究中，最具代表性的品种是卡犬。1995年Livre起源法国（低）统计给出606法国斗牛犬和2808可卡犬注册与5911和6604（分别）2021.17法国斗牛犬显著增加流行自2000年代初以来，在2000年和2021年之间，增加了135%。短头型形态的流行导致了某些疾病的遗传选择，如特应性皮炎、该品种的耳道解剖构象缺陷和OE/OM易感性。

 

 

Prevalence of OM

OM发病率

In our study, of 18 dogs with signs of otitis, 13 (72%) had OM. These results confirm a high rate of OM associated with chronic OE. This value is higher than those in the studies by Belmudes et  al., who reported a prevalence of tomodensitometry lesions of the middle ear of 32.9%, and by Love et al., who found a prevalence rate of 66%, yet lower than the rate of 82.6% in the study by Cole et al. However, this comparison should be viewed with caution. The recruitment in our study concerned dogs with chronic otitis and whose owners agreed to perform a CT scan at their expense in order to diagnose the presence or absence of OM. As a result, sampling favoured the selection of cases where there was high willingness of the owners to conduct examinations. This contrasts with the studies mentioned above which were either retrospective studies analysing data collected over a defined period in the dermatology department for reasons related to the ears, or funded studies in a university setting.

在我们的研究中，在18只有耳炎症状的犬中，有13只（72%）患有OM。这些结果证实了较高的OM发生率与慢性OE相关。这个值高于Belmudes等人的研究，报道的中耳发病率32.9%，和Love等人的研究患病率为66%，但低于Cloe等人研究的82.6%。然而，这种比较应该谨慎看待。我们的研究招募的是患有慢性耳炎的犬，它们的主人同意自费进行CT扫描，以诊断是否存在OM。因此，抽样倾向于选择宠主很愿意进行检查的案例。这与上述研究中提到的研究形成了对比，这些研究要么是回顾性研究，分析在皮肤科收集的特定时期的数据，要么是在大学环境中资助的研究。

 

These results nonetheless clearly highlight the frequency of OM in chronic OE and should encourage systematic searching for this perpetuating factor and proposal of more appropriate management of chronic or recurrent otitis, especially in predisposed breeds.

尽管如此，这些结果清楚地强调了慢性OE中OM的频率，并应鼓励系统地寻找这一持久因素，并建议对慢性或复发性耳炎进行更适当的治疗，特别是在易感品种中。

 

Severity criteria (OTIS3, suppuration, osteitis)

严重程度标准(OTIS3、化脓性、骨炎）

It is interesting to examine the correlation between the CRP values and different severity criteria such as OTIS3 score, suppuration, signs of osteitis and calcification. The OTIS3 score is a lesion score for OE. This simple tool makes it possible to quantitatively assess the state of the lesional severity of the external ear canal. It comprises four items, all classified from 0 to 3: erythema, hyperplasia, discharge and ulcers, both in the vertical and the horizontal ear canals. The maximum score is 12, and a score of <4 is considered to reflect a healthy ear unless ulcers or hyperplasia are present.

研究CRP值与不同的严重程度标准，如OTIS3评分、化脓性、骨炎的症状和钙化之间的相关性是很有趣的。OTIS3评分是OE的病变评分。这个简单的工具使定量评估外耳道病变的严重程度成为可能。它包括四个项目，所有分类从0到3：发红、增生、分泌物和溃疡，都在垂直和水平耳道。最高评分为12分，<评分为4分被认为反映了一个健康的耳朵，除非存在溃疡或增生。

 

The OTIS3 score directly measures the degree of severity of otitis and, therefore, inflammation. In our study, we found a statistically positive relationship between the highest OTIS3 score and the CRP value (p=0.04) indicating that CRP does reflect localised otic inflammation, particularly as the dogs had been screened for any adjunctive disease. Whether this has clinical relevance is debatable; the magnitude of the effect observed was small. Although dogs with a high CRP had a tendency to have high OTIS scores, many individuals with high OTIS scores had a low CRP. Furthermore, our results relied on a limited number of animals, and further studies based on more cases would be warranted to better evaluate the correlation found here. Moreover, the OTIS3 score can be difficult to evaluate properly in cases where the ears are painful, or in French bulldogs, where the horizontal ear canal is anatomically narrow. In our study, all the OTIS3 scores were determined during the general anaesthesia for the CT scan and video-otoscopy, resulting in a more reliable result.

OTIS3评分直接衡量耳炎的严重程度，因此，也可评估炎症。在我们的研究中，我们发现最高的OTIS3评分与CRP值之间存在统计学正相关关系（p=0.04），表明CRP确实反映了局部耳部炎症，特别是在犬被筛查为任何辅助疾病时。这是否具有临床相关性还有待争议；观察到的效果幅度很小。虽然CRP高的犬有OTIS得分高的倾向，但许多OTIS得分高的个体的CRP较低。此外，我们的结果依赖于有限数量的动物，基于更多病例的进一步研究，以更好地评估这里发现的相关性。此外，在耳朵疼痛的情况下，或在水平耳道在解剖学上狭窄的法国斗牛犬中，OTIS3评分可能很难进行正确的评估。在我们的研究中，所有的OTIS3评分都是在CT扫描和视频耳镜下确定的，得到更可靠的结果。

 

In addition, OTIS scores should normally be treated as categories (ordinate) and not numerical, in the sense that they do not represent quantification with biologically equal steps between digits. A larger study may increase the significance of these results.

此外，OTIS分数通常应该被视为类别（纵坐标）而不是数字，因为它们并不代表在生物学上相等的数字之间的长度的量化。一个更大的研究可能会增加这些结果的重要性。

 

CONCLUSION

结论

Plasma CRP concentration is not reliable as a discriminatory tool in cases of otitis, although there is a trend for elevation in cases with more severe disease. However, a larger study may provide a statistically more reliable correlation between OM severity and CRP levels. Our study confirms the usefulness of carrying out an extended imaging assessment such as a CT scan or MRI.

血浆CRP浓度作为耳炎病例的鉴别工具并不可靠，但在病情较严重的病例中有升高的趋势。然而，更大的研究可能提供OM严重程度和CRP水平之间统计学上更可靠的相关性。我们的研究证实了进行扩展成像评估的有效性，如CT扫描或MRI。

 

TABLE 2 Clinical and paraclinical examinations were carried out at initial inclusion visit by group.

表2各组在首次纳入就诊时进行临床和临床旁检查。

Procedure	H	CO	OM
Clinical examination 临床体格检查	•	•	•
C-reactive protein measurementc反应蛋白测定	•	•	•
OTIS3 scoreOTIS3分数	•	•	•
Ear cytological evaluation耳细胞学评价		•	•
Biochemical investigation生化生化检查		•	•
Albumin血清蛋白		•	•
Calcium (Ca++)血清钙		•	•
Urinalysis尿液分析		•	•
CBC血常规		•	•
Computed tomography scan计算机断层扫描，CT扫描		•	•

Abbreviations: CO, chronic otitis group; H, healthy group; OM, otitis media group; OTIS3, 0–3 Otitis Index Scores 3; •, presence.

缩写：CO，慢性耳炎组；H，健康组；OM，中耳炎组；OTIS3,0-3耳炎指数评分3；•，存在。

 

 

 

杨先生

南海

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