玻尿酸鈉
玻尿酸鈉（通常稱為玻尿酸或 HA）是一種天然存在的高黏度黏多醣，大量存在於結締組織、關節滑液、臍帶和眼睛的玻璃體中。在獸醫學中，它主要用於治療滑膜炎和骨關節炎，特別是當未伴隨嚴重的退化性關節疾病或全層軟骨缺損時。 **關鍵臨床要點：** * **分子量 (MW) 差異：** 市售產品的分子量差異很大。當需要避免滑膜沾黏和血管翳形成（例如術後碎片移除）時，通常首選高分子量產品 (>1x10^6)，因為它們能抑制滑膜纖維母細胞的增生。低分子量產品通常較便宜，也能有效改善關節疾病的症狀。 * **來源：** 許多商業獸醫 HA 產品提取自公雞冠，但也有生物發酵來源的產品。 * **給藥方式：** 主要透過關節內 (IA) 或靜脈內 (IV) 注射給藥，不過口服凝膠製劑也已證實能有效減少馬匹術後的關節積液。
作用機制: Hyaluronate sodium provides both mechanical and pharmacological benefits to the diseased joint: * **Mechanical Support:** Restores the viscoelastic properties of synovial fluid, providing a cushioning effect and boundary lubrication for articular cartilage. * **Anti-inflammatory Pathway:** * **Free Radicals** → Scavenged directly by HA molecules, reducing oxidative damage within the joint capsule. * **Prostaglandins** → Synthesis and release are suppressed, mitigating local inflammation and pain. * **Cellular Modulation:** Reduces the influx of inflammatory proteins and leukocytes into the joint space. Interacts with **CD44 receptors** on synoviocytes and macrophages to downregulate pro-inflammatory cytokines.
各物種劑量
- Keratoconjunctivitis sicca (dry eye) or corneal ulceration · 1-2 drops per eye · Topical · q4h to q12h (or as needed) · As needed · Frequency depends on the severity of the condition and the viscosity of the product.
- Ocular lubrication / corneal ulceration · 1 drop per eye · Topical · q4h to q12h · As needed · Frequency depends on the severity of the condition.
- Osteoarthritis / Synovitis (Hylartin-V, Hyvisc, Hyalovet) · 20 mg · IA · As directed · Check individual product label for specific dosing.
- Osteoarthritis / Synovitis (Equron) · 10 mg · IA · As directed · Check individual product label for specific dosing.
- Osteoarthritis / Synovitis (Synacid) · 50 mg · IA · As directed · Check individual product label for specific dosing.
- Osteoarthritis / Synovitis (Legend) · 40 mg IV or 20 mg IA · IV/IA · As directed · Check individual product label for specific dosing.
- Reduce joint effusion post-arthroscopic surgery for osteochondritis dissecans (OCD) · 100 mg · PO · once daily · 30 days · Administered as an oral gel (Conquer)
- Ocular lubrication / corneal trauma · 1 drop per eye · Topical · q6h to q12h · As needed · Use with care to avoid stressing the bird during frequent handling.
給藥途徑
禁忌症
- Injection through skin that has been recently fired or blistered
- Injection through skin with excessive scurf or counterirritants
- Use as a substitute for adequate diagnosis (e.g., failing to rule out fractures via radiography)
- Hypersensitivity to hyaluronate or any component of the formulation
不良反應
- Local joint flare (heat, swelling, and/or effusion) post-injection
- Increased incidence of flares when combined with other intra-articular drugs
- Mild transient ocular irritation (rare)
- Temporary blurred vision immediately after application (especially with higher viscosity gels)
監測
- Resolution of clinical signs (lameness, joint effusion)
- Injection site for signs of local reaction (heat, swelling, pain) within 24-96 hours post-injection
- Resolution of clinical signs (e.g., blepharospasm, conjunctival hyperemia)
- Corneal ulcer healing via fluorescein staining
- Schirmer tear test (STT) for dry eye management
過量
Acute toxicology studies performed in horses have demonstrated no systemic toxicity associated with overdoses.
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