1、2005-6-15XIA Zhaofei PhD DVM 1Feline Hepatic Lipidosis 猫肝脏脂肪沉积综合症夏兆飞 博士中国农业大学动物医学院2005-6-15XIA Zhaofei PhD DVM 22005-6-15XIA Zhaofei PhD DVM 32005-6-15XIA Zhaofei PhD DVM 42005-6-15XIA Zhaofei PhD DVM 5临床病例介绍临床病例介绍 病猫名字：咪咪 年龄：2.5岁 体重：6.4公斤 性别：雄性，已经去势 食物：超市购买猫粮2005-6-15XIA Zhaofei PhD DVM 6 主诉：主诉：该猫原
2、来能吃能喝，身体肥胖，23周以来，吃食逐渐减少，精神不振，体重下降，现在基本不吃，流涎，呕吐。临床检查：临床检查：眼球凹陷，皮肤松弛，毛细血管再充盈时间延长，粘膜及皮肤黄染，精神极差，处于半昏睡状态。T37.8。2005-6-15XIA Zhaofei PhD DVM 7下一步怎么办？下一步怎么办？检查哪些项目？检查哪些项目？2005-6-15XIA Zhaofei PhD DVM 8实验室检查实验室检查 CBC:RBC,Hb,PCV 升高 WBC稍高 生化检查：生化检查：ALT,AST 明显升高 ALP,GGT明显升高 总胆红素和直接胆红素显著升高2005-6-15XIA Zhaofei P
3、hD DVM 9 确诊什么疾病？确诊什么疾病？治疗原则和方法？治疗原则和方法？2005-6-15XIA Zhaofei PhD DVM 10临床病例临床病例夏兆飞 博士中国农业大学动物医学院2005-6-15XIA Zhaofei PhD DVM 11Introduction Feline Hepatic Lipidosis 猫肝脏脂肪沉积综合症 Fatty Liver Syndrome 脂肪肝2005-6-15XIA Zhaofei PhD DVM 122005-6-15XIA Zhaofei PhD DVM 13The liver:manager of metabolism肝脏：机体的代谢
4、器官肝脏：机体的代谢器官q More than 1500 functions 超过1500种功能Maintenance of nutrient metabolism 维持营养物质的代谢Control of hormonal balance 控制激素的平衡Haemostasis and coagulation 止血和凝固作用Distribution and detoxification of endogenous waste 内源性废弃物的分配和解毒作用Immune function 免疫功能q Blood flow 20/80 血流量 20/802005-6-15XIA Zhaofei PhD
5、 DVM 14 Feline hepatic lipidosis is a common condition in cats in which the liver accumulates a large amount of fat and the liver cannot function normally.FHL是猫常发病，肝脏内沉积大量的脂肪，影响肝脏的正常功能。It is a very serious disease,and unless treated aggressively,can be fatal.这是一种非常严重的疾病，且是致命性的，除非进行积极的治疗。2005-6-15XIA
6、 Zhaofei PhD DVM 152005-6-15XIA Zhaofei PhD DVM 16 When an additional disease state is found to be the cause of the anorexia,the hepatic lipidosis is defined as secondary.“当确诊是其他某种疾病引起的厌食时，那么肝脏脂质沉积综合症就为“继发性的”。The term primary or idiopathic hepatic lipidosis is used when an additional disease state c
7、annot be identified.当确诊没有其他疾病发生时，那么就为“原发性”或“自发性”肝脏脂质沉积综合症。2005-6-15XIA Zhaofei PhD DVM 17 Without aggressive medical intervention,this vicious circle can,lead to death in over 90 per cent of the cats.如不进行临床治疗，那么机体恶性循环就会导致患猫90%以上的死亡率。2005-6-15XIA Zhaofei PhD DVM 18What causes feline hepatic lipidosis
8、?/病因？病因？2005-6-15XIA Zhaofei PhD DVM 19 Feline hepatic lipidosis can occur because of 病因包括 Nutritional,营养性因素 Metabolic,代谢性因素 Stress,应激性因素 or toxic injury to the liver.肝脏的毒性损伤2005-6-15XIA Zhaofei PhD DVM 20Most cases of feline hepatic lipidosis are associated with obesity.大多数FHL患猫都为肥胖猫2005-6-15XIA Zh
9、aofei PhD DVM 21 Approximately 50%of cases,however,are called idiopathic,meaning we do not know what has caused the condition,although almost all cases are associated with obesity.近50%的病例为“原发性的”，尽管大多数病例都与肥胖有关，但IHL发病原因目前仍不清楚。2005-6-15XIA Zhaofei PhD DVM 222005-6-15XIA Zhaofei PhD DVM 23 Obese cats!/肥
10、胖猫！2005-6-15XIA Zhaofei PhD DVM 24FHL has been associated with与FHL相关的疾病 diabetes mellitus,糖尿病糖尿病 hyperthyroidism,甲状腺机能亢进甲状腺机能亢进 feline lower urinary tract disease(FLUTD),猫下泌尿道疾病猫下泌尿道疾病（FLUTD）heart disease,心脏病 kidney disease,肾脏疾病 chronic upper respiratory disease,慢性上呼吸道疾病 cancer,癌症 pancreatitis.胰腺炎20
11、05-6-15XIA Zhaofei PhD DVM 25 Stress seems to trigger the disease.应激被认为是FHL的激发性因素。Stresses can include:应激包括：a change in diet,饮食的改变，a concurrent disease such as a bacterial infection,并发性疾病如细菌感染，a change in the environment(new home,new baby,new pet,etc.),or 生活环境的改变（新房间、婴儿、新宠物等），a prolonged decrease in
12、 appetite for other reasons.其他病因引起的长期食欲下降。2005-6-15XIA Zhaofei PhD DVM 26 Unfortunately,once this disease develops,cats feel ill and may not begin to eat again 随着FHL病情的发展，患猫会变得不吃不喝。even if the,initial cause of their loss of appetite has been eliminated.即使最初引起食欲下降的病因消失，患猫仍会不吃不喝。2005-6-15XIA Zhaofei P
13、hD DVM 27What are the mechanism of hepatic lipidosis?/发病机制？发病机制？2005-6-15XIA Zhaofei PhD DVM 28 Cats are unique in their tendency to develop this disorder.猫易发生肝脏脂肪代谢紊乱。Excessive amounts of fat are broken down from the cats peripheral fat storage tissue during fasting.禁食期间，机体动员大量的外周脂肪以提供能量。2005-6-15X
14、IA Zhaofei PhD DVM 29 This fat is then transported to the liver.外周脂肪分解后以脂肪酸的形式被运输到肝脏。The liver should then process this fat and export it to the rest of the body in a new form.肝脏对脂肪酸进行氧化和酯化后形成甘油三酯并释放入机体其他器官。2005-6-15XIA Zhaofei PhD DVM 30 In cats that develop hepatic lipidosis this process is impair
15、ed and the rate of fat export from the liver is much slower than the rate of fat intake,resulting in liver fat accumulation.猫患FHL时,肝脏代谢脂肪的功能受到损伤,肝脏代谢脂肪的速度慢于摄取脂肪的速度,导致肝脏脂肪的沉积。2005-6-15XIA Zhaofei PhD DVM 31 Damage to the liver is caused by swelling of liver cells filled with fatty deposits as well as
16、 additional processes.由脂肪沉积引起的肝细胞肿胀和其他因素造成肝功能损伤。2005-6-15XIA Zhaofei PhD DVM 32肉毒碱肉毒碱脂肪酸脂肪酸线粒体线粒体能量代谢能量代谢2005-6-15XIA Zhaofei PhD DVM 33脂肪酸脂肪酸线粒体线粒体膜膜能量能量2005-6-15XIA Zhaofei PhD DVM 34What are the signs of hepatic lipidosis?/症状？症状？2005-6-15XIA Zhaofei PhD DVM 35 Most cats with feline hepatic lipido
17、sis are 患FHL的病猫大多为 older,成年猫 overweight,超重 and have gone through some stress which has caused a decrease or lack of appetite.有应激史引起的食欲下降或丧失。2005-6-15XIA Zhaofei PhD DVM 36 Most cats with hepatic lipidosis become depressed and the decreased appetite continues over the course of days to weeks.大多数患猫都精神
18、沉郁、食欲下降且持续数天至数周。2005-6-15XIA Zhaofei PhD DVM 37 Many cats,then,will have lost a considerable amount of weight before they are seen by a veterinarian.一些患猫体重下降明显后才被送去就诊。Many cats lose a large amount of muscle mass.许多患猫肌肉（尤其是横纹肌）大量的消耗。Sporadic vomiting is common,偶尔呕吐，as is jaundice.黄疸。2005-6-15XIA Zhao
19、fei PhD DVM 382005-6-15XIA Zhaofei PhD DVM 39 Some cats may develop hepatic encephalopathy,an abnormality of the brain function due to liver disease.一些患猫会继发肝脑病。These cats may appear to be more depressed and lethargic.发生肝脑病的患猫精神更加的沉郁且嗜睡。2005-6-15XIA Zhaofei PhD DVM 402005-6-15XIA Zhaofei PhD DVM 41Co
20、mmon Symptoms FHL的常见临床症状的常见临床症状 anorexia,厌食 weight loss,减重 lethargy,嗜睡 vomiting,呕吐 jaundice(yellow tinge to the skin,inside of the ears,and gums),and 黄疸（皮肤、耳内廓和齿龈黄染）2005-6-15XIA Zhaofei PhD DVM 42 occasionally behavioral or neurologic signs such as 偶尔出现行为改变或神经症状行为改变或神经症状，如 excessive drooling,流涎增多 bl
21、indness,失明 semicoma or coma,and 半昏迷或昏迷 seizures.癫痫2005-6-15XIA Zhaofei PhD DVM 43How is hepatic lipidosis diagnosed?/诊断？诊断？2005-6-15XIA Zhaofei PhD DVM 44Supplementary examinations/辅助检查2005-6-15XIA Zhaofei PhD DVM 45 History:The history of an overweight cat losing his appetite and losing weight woul
22、d give the veterinarian the suspicion that the symptoms could be indicative of hepatic lipidosis(among other things).病史：患猫有超重史，食欲下降且体重减轻。根据这些，患猫可疑似为FHL。2005-6-15XIA Zhaofei PhD DVM 46 Physical Exam:On a physical exam,the liver may or may not feel enlarged.身体检查：肝脏触诊可能增大。Overweight cat that has lost m
23、uscle mass.猫虽肥胖但肌肉松弛。Jaundice may be present which would be highly suggestive of a liver disease.黄疸表明发生肝脏疾病。2005-6-15XIA Zhaofei PhD DVM 47 Laboratory Findings:/实验室诊断：SAP（ALP）is markedly elevated.SAP（ALP）显著增高。ALT(SGPT)and AST(SGOT)are usually increased.ALT(SGPT)和AST(SGOT)都增高。CK and GGT are usually m
24、odestly increased.CK和GGT都轻度增高。Serum K+is usually decreased.血清K+浓度减少。2005-6-15XIA Zhaofei PhD DVM 48 The bilirubin(a breakdown product of red blood cells,which is normally eliminated by the liver)can be increased above normal as well.胆红素浓度（为红细胞裂解产物，在肝内代谢）升高于正常值。The results of a bile acid test would b
25、e abnormal.胆汁酸检测发生异常。2005-6-15XIA Zhaofei PhD DVM 49 Some cats may be anemic,一些猫发生贫血。and have decreased clotting ability in their blood.血液凝固性下降。2005-6-15XIA Zhaofei PhD DVM 50 Radiographs(X-rays):The liver may appear normal in size or enlarged.X-rays检查：检查：肝影可能正常或增大。Ultrasound:Typical changes can be
26、seen in the liver and the ultrasound can rule out some other causes of the symptoms and laboratory abnormalities.B超检查：超检查：肝脏回声杂乱，且可排除其他相关病因。2005-6-15XIA Zhaofei PhD DVM 51 Biopsy:The way to definitively diagnose hepatic lipidosis is through a liver biopsy or fine needle aspirate.活组织检查：活组织检查：可通过肝脏活组织
27、检查或细针穿刺抽吸肝细胞进行确诊。2005-6-15XIA Zhaofei PhD DVM 52Histophotomicrograph of liver tissue in a normal cat(a)and a cat with FHL(b)高倍镜下观察正常猫（a）和FHL病猫（b）的肝组织2005-6-15XIA Zhaofei PhD DVM 53What is the treatment of feline hepatic lipidosis?/治疗？治疗？2005-6-15XIA Zhaofei PhD DVM 54 The keys to successful manageme
28、nt of cats with lipidosis are 成功治疗FHL患猫的关键因素 early diagnosis and 早期诊断 intensive nutritional support.及时进行营养支持疗法。2005-6-15XIA Zhaofei PhD DVM 55 The cornerstone of therapy,the only way to reverse the process of fat accumulation in the liver,is aggressive feeding to supply your cat with his or her full
29、 caloric requirements.唯有缓解肝脏脂肪的沉积，为患猫补充其全部的能量需求是治疗的基石。2005-6-15XIA Zhaofei PhD DVM 56 Change in Diet:Cats will need to have nutritional support for 3-6 weeks.改变饮食：改变饮食：患猫需要3-6周的营养支持疗法。The cat is fed a high-protein,calorie-dense food.饲喂患猫高蛋白、高能量的食物。2005-6-15XIA Zhaofei PhD DVM 57 A product that provi
30、des is recommended:推荐的食物要含：30%to 50%of metabolizable energy(ME)calories as protein,蛋白质可提供30%-50%代谢能（ME）30%to 40%as fat,and 脂肪可提供30%-40%的代谢能 20%to 30%as digestible carbohydrate 碳水化合物可提供20%-30%的代谢能2005-6-15XIA Zhaofei PhD DVM 58 Cats have a high maintenance requirement for dietary protein.猫对食物蛋白的需求量高。
31、Protein malnutrition may play a role in the development of HL or be a consequence of prolonged anorexia.蛋白质缺乏可能是HL的诱因或长期厌食的诱因。Thus,protein should not be restricted in cats with HL,except when overt signs of hepatic encephalopathy are present.因此患有HL的病猫不应限制蛋白质的摄入，但肝脑病除外。2005-6-15XIA Zhaofei PhD DVM 59
32、 Cats that show clinical signs of hepatoencephalopathy initially need to be fed a reduced-protein diet.表现肝脑病的患猫开始时应饲喂低蛋白食物。Protein content can be gradually increased as neurological signs resolve.蛋白质的含量可逐渐随着神经症状的缓解而增加。2005-6-15XIA Zhaofei PhD DVM 60 Because of the absolute requirement of cats for ta
33、urine and arginine,these amino acids should be supplemented.由于猫对牛磺酸和精氨酸的特殊需要，还要额外地补充这些氨基酸。2005-6-15XIA Zhaofei PhD DVM 612005-6-15XIA Zhaofei PhD DVM 62 Force feeding is usually not a good idea.强迫饲喂不是好的办法。强迫饲喂不是好的办法。Most cats resent force feeding,are uncooperative,become stressed,and rarely eat suff
34、icient amounts of food for effective treatment.多数猫厌恶强饲而不配合，会造成对猫的应激，由于不能食入足够的分量而影响治疗效果。2005-6-15XIA Zhaofei PhD DVM 63 Cats with HL are very ill and severely stressed;thus,additional stress should be avoided.患有HL的病猫病情严重且不耐应激，因此应避免对猫的应激避免对猫的应激。Cats also seem to develop food aversions rapidly,and the
35、association between food and the unpleasant experience of forcing may delay the cats return to eating.患猫也会表现对食物的厌恶情绪，通常会把食物与不愉快的被强迫经历联系在一起，延长患猫恢复自主进食的时间。2005-6-15XIA Zhaofei PhD DVM 64 Therefore,in the clinical phase of the disease the only reliable treatment option is tube feeding.因此，FHL患猫的病程只与治疗时所
36、采用的管只与治疗时所采用的管饲有关饲有关。2005-6-15XIA Zhaofei PhD DVM 65 Feeding Tubes:In almost all cases,a feeding tube needs to be placed.管饲：管饲：大多数病例需要放置导管饲喂。There are three types of feeding tubes commonly used for this disease.此病可采用3种饲喂管 Nasoesophageal,鼻饲管 esophagostomy,and 食道造口术 gastrostomy tubes.胃造口术2005-6-15XIA
37、Zhaofei PhD DVM 66 The type of tube used depends on 饲管类型的选择依据 the size of the cat,猫的体型 the seriousness of the illness(can the cat be anesthetized?),and 病情的严重性（能否麻醉）the preference of the veterinarian and owner.兽医和主人的偏好2005-6-15XIA Zhaofei PhD DVM 672005-6-15XIA Zhaofei PhD DVM 68 Appetite Stimulants:
38、Appetite stimulants such as diazepam are usually NOT effective because they are best used in cats who still have some appetite and interest in food.刺激食欲：刺激食欲：地西泮通常效果不好，一般用于仍有食欲的病猫。Chronic administration(7 days)of diazepam PO to cats has been associated with fulminant hepatic necrosis.患猫口服地西泮7天以上，会突发
39、肝坏死肝坏死。2005-6-15XIA Zhaofei PhD DVM 69 Fluids and Electrolytes:Many cats with hepatic lipidosis are dehydrated.水和电解质：水和电解质：许多患猫都会发生脱水。Crystalloid fluids are used to replete hydration and to provide contemporary losses 晶体液体可用于纠正脱水并补充正在丢失水量。2005-6-15XIA Zhaofei PhD DVM 70 Avoiding lactate-containing f
40、luids seems prudent based on high lactate values shown in some cases.避免使用含乳酸的液体，因某些病例血清乳酸含量很高。If the cat has had significant vomiting,the potassium level in the blood is often low and needs to be supplemented.如果患猫呕吐严重，那么血清K+的浓度会下降，需要补钾。2005-6-15XIA Zhaofei PhD DVM 71 Vitamin Supplementation:The live
41、r is responsible for making the factors that help blood to clot.补充维生素补充维生素：促进肝脏合成促凝血因子。It needs vitamin K to do this.还要补充维生素K。2005-6-15XIA Zhaofei PhD DVM 72 Normally,the liver stores vitamin K so it is readily available.正常时，肝脏可储存维生素K。Cats with hepatic lipidosis may need supplemental vitamin K to co
42、rrect a coagulation(clotting)problem.FHL患猫需要补充维生素K 以纠正凝血问题。2005-6-15XIA Zhaofei PhD DVM 73 A multiple vitamin supplement is recommended.建议补充复合维生素复合维生素。Vitamin B1 and B12 deficiency can occur as a result of long periods of anorexia,so thiamine supplementation is of particular importance.由于长期的厌食，易造成维生
43、素B1和维生素B12 的缺乏，因此还要额外补充维生素B1。2005-6-15XIA Zhaofei PhD DVM 74 Gastrointestinal Medications:Drugs such as cimetidine(Tagamet)or ranitidine(Zantac)are often used to prevent ulceration of the stomach or intestine.胃肠道用药：胃肠道用药：如西咪替啶西咪替啶（泰胃美）或雷尼替雷尼替丁丁（善得胃）用于抑制胃或肠道发生溃疡。2005-6-15XIA Zhaofei PhD DVM 75 Medica
44、tions such as metoclopramide are often given to decrease vomiting and stimulate the movement of food through the stomach and intestine.胃复安胃复安可用于减少呕吐和刺激胃肠道的运动。2005-6-15XIA Zhaofei PhD DVM 76 Antibiotics:Because these cats are very stressed,their immune system may not function adequately.抗生素：抗生素：因猫受到应
45、激造成免疫力下降。As a preventive measure,antibiotics such as amoxicillin are sometimes given.可使用阿莫西林阿莫西林进行预防性治疗。2005-6-15XIA Zhaofei PhD DVM 77What is the prognosis for cats with hepatic lipidosis?/预后？预后？2005-6-15XIA Zhaofei PhD DVM 78 Even with intensive care,approximately 35%of cats with hepatic lipidosis
46、 die from the disease.尽管进行积极的治疗，仍有近仍有近20-35%20-35%的的FHL患猫死亡患猫死亡。Cats who do recover generally do so in 3-6 weeks,however,some may need continued nutritional support for months.患猫需要3-63-6周周才能最终康复，但一些患猫仍需几个月的营养支持治疗。2005-6-15XIA Zhaofei PhD DVM 79 Generally,the damage to the liver is reversible,and the
47、 condition rarely recurs.一般地，肝脏的损伤是可逆的，且不会再复发。2005-6-15XIA Zhaofei PhD DVM 80How is hepatic lipidosis prevented?/预防？预防？2005-6-15XIA Zhaofei PhD DVM 81 Owners play an important role in preventing hepatic lipidosis.宠物主人对猫脂肪肝的预防起着重要作用。By keeping your cat in a healthy body condition,you can greatly redu
48、ce his risk of developing this disease.维持猫的健康体重健康体重，会减少发生脂肪肝的危险 性。2005-6-15XIA Zhaofei PhD DVM 82 Overweight or obese?超重或肥胖 120%110-120%80-90%90-110%Ideal body weight=100%2005-6-15XIA Zhaofei PhD DVM 83Scarlett and Donoghue,1998 4 yr follow-up n=1457 catsConsequences of Feline Obesity肥胖猫的相关疾病 糖尿病糖尿病
49、 跛行跛行 皮肤病皮肤病2005-6-15XIA Zhaofei PhD DVM 84 Care must be taken in developing weight reduction programs for obese cats.肥胖猫必须进行减肥计划。减肥计划。2005-6-15XIA Zhaofei PhD DVM 85 Greatly restricting intake or using a food the obese cat will not eat could incite the development of hepatic lipidosis.过度地限制肥胖猫的饮食会诱
50、发猫肝脏脂肪沉积综合症。2005-6-15XIA Zhaofei PhD DVM 86Obesity causes/肥胖的原因2005-6-15XIA Zhaofei PhD DVM 872005-6-15XIA Zhaofei PhD DVM 882005-6-15XIA Zhaofei PhD DVM 89 Obese cats who lose their appetite for any reason should be considered candidates for developing hepatic lipidosis and nutritional support shou
