背景:犬利什曼病(CanL),由婴儿利什曼原虫引起的,是一种重要的媒介传播寄生虫病,对人类健康有影响。尽管取得了进步,由于其复杂性,管理CanL仍然具有挑战性,尤其是在慢性,复发病例。数学建模已成为各种医学领域的强大工具,但其在了解CanL复发中的应用仍有待探索。
方法:这项回顾性研究旨在调查自然感染L.infantum的一组狗中与疾病复发相关的危险因素。包括来自满足纳入标准的54只狗的291个重复测量的数据。创建了两个逻辑混合效应模型,以确定与需要在CanL中进行利什曼杀药治疗的临床复发风险增加相关的临床病理变量。采用了向后淘汰的方法,从包含所有潜在预测因子的完整模型开始。变量根据它们对模型的影响进行迭代剔除,同时考虑统计意义和模型复杂性。所有分析均使用R软件进行,主要采用lme4包,并应用5%的显著性水平(P<0.05)。
结果:本研究确定了与需要杀利什曼治疗的复发风险增加相关的临床病理变量。模型1显示,白蛋白/球蛋白比(A/G)比率每增加0.1,需要治疗的几率降低了45%.相反,总临床评分(CS)每增加一个单位,需要治疗的几率增加22-30%。间接免疫荧光抗体测试(IFAT)不是模型1中的显着风险因素。模型2,结合单个白蛋白和球蛋白值,显示IFAT滴度高的狗,高β-球蛋白血症,低蛋白血症,贫血,高CS的复发风险增加。两种模型都表现出良好的拟合,并解释了治疗决策中的大量可变性。
结论:表现出较高CS的狗,蛋白异常血症,贫血,在CanL中,高IFAT滴度在临床复发时需要利什曼治疗的风险增加。定期监测和评估危险因素对于早期发现CanL病例的复发和有效干预至关重要。两个模型之间的对比发现突出了影响该疾病治疗决策的方面的复杂性,以及量身定制的管理策略以改善受影响的狗的结果的重要性。
BACKGROUND: Canine leishmaniosis (CanL), caused by Leishmania infantum, is an important vector-borne parasitic disease in dogs with implications for human health. Despite advancements, managing CanL remains challenging due to its complexity, especially in chronic, relapsing cases. Mathematical modeling has emerged as a powerful tool in various medical fields, but its application in understanding CanL relapses remains unexplored.
METHODS: This retrospective study aimed to investigate risk factors associated with disease relapse in a cohort of dogs naturally infected with L. infantum. Data from 291 repeated measures of 54 dogs meeting the inclusion criteria were included. Two logistic mixed-effects models were created to identify clinicopathological variables associated with an increased risk of clinical relapses requiring a leishmanicidal treatment in CanL. A backward elimination approach was employed, starting with a full model comprising all potential predictors. Variables were iteratively eliminated on the basis of their impact on the model, considering both statistical significance and model complexity. All analyses were conducted using R software, primarily employing the lme4 package, and applying a significance level of 5% (P < 0.05).
RESULTS: This study identified clinicopathological variables associated with an increased risk of relapses requiring a leishmanicidal treatment. Model 1 revealed that for each 0.1 increase in the albumin/globulin ratio (A/G) ratio, the odds of requiring treatment decreased by 45%. Conversely, for each unit increase in the total clinical score (CS), the odds of requiring treatment increase by 22-30%. Indirect immunofluorescence antibody test (IFAT) was not a significant risk factor in model 1. Model 2, incorporating individual albumin and globulins values, showed that dogs with high IFAT titers, hyper beta-globulinemia, hypoalbuminemia, anemia, and high CS were at increased risk of relapse. Both models demonstrated a good fit and explained a substantial amount of variability in treatment decisions.
CONCLUSIONS: Dogs exhibiting higher CS, dysproteinemia, anemia, and high IFAT titers are at increased risk of requiring leishmanicidal treatment upon clinical relapse in CanL. Regular monitoring and assessment of risk factors prove essential for early detection of relapses and effective intervention in CanL cases. The contrasting findings between the two models highlight the complexity of aspects influencing treatment decisions in this disease and the importance of tailored management strategies to improve outcomes for affected dogs.