臺灣博碩士論文加值系統

二尖瓣閉鎖不全導致血液逆流是目前臨床心臟疾病比例最高的疾病，主要病因是瓣膜發生慢性退行性變化所造成。此疾病主要發生於中小型犬，且發生比例隨年齡增加而上升。為了解犬心臟疾病於中台灣之流行病學特徵，本研究將調查2006年中興大學獸醫教學醫院門診病例二尖瓣逆流之盛行率，品種，年齡與性別之得病風險值；並進而將病程嚴重度以臨床症狀、心雜音級數與彩色杜卜勒超音波逆流範圍與左心房主動脈比分別區分後進行評估。經統計分析後，門診犬心臟病例數共有554例，其中384例患有二尖瓣逆流，佔69.3%，平均年齡為11.3±3.1歲，十歲齡以上老犬的危險勝算比為小於五歲齡犬隻的59.1倍 (p<0.05)，十三歲齡以上的犬隻盛行率超過33.0%。小型犬的得病風險為大型犬的20.5倍 (p<0.05)。中小型犬趨勢檢定的結果，以日本狆之危險風險最高，其次為博美犬、馬爾濟斯犬 (p<0.05)，其中初次診斷年齡以日本狆平均年齡最低，為8.4±3.21歲。公犬與母犬之得病風險無顯著差異。在評估二尖瓣逆流嚴重度方面，心雜音級數與臨床症狀無顯著相關，而與超音波結果有顯著相關；心衰竭級數越嚴重時分數加總也越高 (p<0.05)。性別與逆流嚴重程度亦無顯著差異。在高得病風險的犬種中，以日本狆、馬爾濟斯犬與狐狸犬與國外文獻提出之犬種不同，臨床診療上值得注意。本研究提供了中臺灣地區犬患二尖瓣逆流疾病流行趨勢及好發品系，相關資料可做為疾病診斷治療與疾病預防之參考。

Chronic valve disease or endocardiosis is the most common form of heart disease in dogs. It is associated with aging and typically causes mitral regurgitation (MR) characterized by a systolic murmur in older dogs. Several small and medium-size breeds are predisposed to developing MR due to myxomatous valvular disease. To discover the epidemiology information of canine MR in central Taiwan area, this retrospective study of clinical cases of year 2006 was carried out. The severity of MR was evaluated by scores of clinical sign, murmur intensities and echocardiography appearance. Sixty nine percentages of heart disease cases have MR (384/554), revealed a mean age of 11.3±3.1 years. The odds ratio of older dogs (>10 years old) was 59.1 to dogs less than 5 years old (p<0.05). The odds ratio of small breeds was 20.5 times to large breeds (p<0.05). The Japanese chin had highest MR risk by Chi- square test for trend (p<0.05), followed by Maltese and Pomeranian. Mean age of 8.4±3.2 years was observed at initial examination of Japanese chin, and was younger than other two breeds. Murmur intensities was not correlated to clinical sign scores, but correlated to echocardiographic scores. The sum of threes scores was correlated to the severity of heart failure. The prevalence rate and severity had no significant difference between male and female. Japanese chin, Maltese and Spitz are first discovered to be predisposed to MR in this study. Relevant information obtained could be applied to assist heart disease diagnosis, treatment and prevention.

中文摘要……………………………………………………………i
英文摘要……………………………………………………………..ii
目錄……………………………………………………………………iii
表次……………………………………………………………………v
圖次…………………………………………………………………..vi
第一章 緒言…………………………………………………………1
第二章 文獻探討
第一節 犬心血管疾病之流行病
一、 犬心血管疾病之盛行率……..……………………………..3
二、 先天性心臟病……….………………………………3
三、 後天性心臟病…………………………………………….6
第二節 犬慢性退行性瓣膜疾病之二尖瓣逆流
一、 流行病學………………………………………………..9
二、 病因學與病理變化………………………………………….10
三、 病態生理變化……………………………………………….11
四、 診斷…………………………………………………..…..13
五、 心衰竭評估…………………………………………………15
六、 治療………………………………………………………….16
第三節 以心臟超音波評估犬之二尖瓣逆流
一、 檢視心臟結構病變………………………………………….18
二、 評估左心室功能……………………………………………19
三、 二尖瓣逆流之偵測………………………………………….19

第三章 材料與方法
第一節 犬隻樣本來源……………………………………………………21
第二節 研究方法………………………………………………………..22
第三節 統計方法…………………………………………………………24
第四章 結果
第一節 流行病學之統計結果
一、 各種心臟疾病之分佈比例…………………….................28
二、 二尖瓣逆流於各犬種之盛行率與得病風險趨勢………..28
三、 年齡………………………………………………………….35
四、 性別………………………………………………………….38
第二節 心臟超音波評估二尖瓣逆流之結果
一、 心臟超音波診斷疾病之比例………………………………..…40
二、 臨床症狀、心雜音強度與超音波結果之關係…………….….40
三、 性別與二尖瓣逆流程度之比較…………………………….….43
第五章 討論
第一節 二尖瓣逆流之流行病學…………………………………………44
第二節 二尖瓣逆流之評估………………………………………………47
第二節 總結………………………………………………………………49
參考文獻………………………………………………………………..………50
附錄一 犬隻樣本分類……………………………………………………….57
附錄二 各犬種之平均年齡………………….……………………………….58
附錄三 犬隻各項評估之分數結果……………………………….…………...59

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