Massive Localized Lymphedema: A Case-Control Study
Massive Localized Lymphedema: A Case-Control Study
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DOI：
10.1016/j.jamcollsurg.2016.10.047
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发表时间：
2017-02-01
影响因子：
5.2
通讯作者：
Greene, Arin K.
中科院分区：
文献类型：
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作者：
Maclellan, Reid A.;Zurakowski, David;Greene, Arin K.
背景：大面积局部性水肿（MLL）是一种与肥胖相关的皮肤和皮下过度生长的区域。本研究的目的是确定MLL是否由肥胖引起的淋巴水肿（OIL）引起，并描述其患病率和危险因素。研究设计：对2009年至2016年期间在我们的淋巴水肿项目中接受评估的患者进行回顾，其中肥胖个体（BMI >= 30 kg/m2）通过淋巴管造影评估下肢淋巴功能。候选变量包括年龄、性别、BMI、水肿持续时间、感染史和淋巴结造影结果。使用多变量逻辑回归确定候选变量与MLL存在之间可能的关联。通过受试者工作特征曲线分析确定BMI预测MLL的最佳截止值。在MLL患者（n = 17）中，所有患者均患有OIL，无原发性或继发性水肿（中位BMI 66 kg/m2;四分位数间距62 - 78）。大面积局部水肿累及大腿（n = 16;双侧= 10，单侧= 6）、生殖器（n = 3）和耻骨上区域（n = 2）。无MLL的对照组患者（n = 65）有原发性（46%）、继发性（37%）或肥胖诱导的（17%）淋巴功能障碍（中位BMI 36 kg/m2;四分位数范围32 - 45）。Logistic回归分析显示BMI与MLL状况之间存在显著关系; BMI > 56 kg/m2的患者发生MLL的几率是BMI = 56 kg/m2的患者的213倍（p < 0.0001）。年龄、性别、肥胖持续时间和感染史与MLL的发生无关（均p > 0.2）。结论：大面积局限性水肿是OIL的后果，约60%的肥胖患者有下肢功能障碍; BMI > 56 kg/m2显著增加风险。肥胖者应该在BMI达到OIL和MLL发展的阈值之前被转诊到减肥中心。（美国科尔外科杂志2017; 224：212-216。(C)2016年美国外科医生学会。爱思唯尔公司出版版权所有© 2016
BACKGROUND: Massive localized lymphedema (MLL) is an area of skin and subcutaneous overgrowth associated with obesity. The purpose of this study was to determine whether MLL results from obesityinduced lymphedema (OIL) and to characterize the prevalence and risk factors for the condition.STUDY DESIGN: Patients evaluated in our Lymphedema Program between 2009 and 2016 were reviewed for obese individuals (BMI >= 30 kg/m(2)) who had lower-extremity lymphatic function evaluated by lymphoscintigraphy. Candidate variables included age, sex, BMI, duration of lymphedema, infection history, and lymphoscintigraphy findings. A possible association between candidate variables and presence of MLL was determined using multivariable logistic regression. Optimal cutoff for BMI in predicting MLL was identified by receiver operating characteristic curve analysis.RESULTS: Eighty-two patients were included in the study population. In patients with MLL (n = 17), all had OIL and none had primary or secondary lymphedema (median BMI 66 kg/m(2); interquartile range 62 to 78). Massive localized lymphedema involved the thigh (n = 16; bilateral = 10, unilateral = 6), genitalia (n = 3), and suprapubic area (n = 2). Control patients without MLL (n = 65) had primary (46%), secondary (37%), or obesity-induced (17%) lymphatic dysfunction (median BMI 36 kg/m2; interquartile range 32 to 45). Logistic regression indicated a significant relationship between BMI and MLL condition; patients with a BMI > 56 kg/m(2) had a 213-times greater odds of MLL developing vs patients with BMI = 56 kg/m(2) (p < 0.0001). Age, sex, duration of obesity, and infection history were not associated with development of MLL (all p > 0.2).CONCLUSIONS: Massive localized lymphedema is a consequence of OIL and affects approximately 60% of obese patients with lower-extremity dysfunction; a BMI > 56 kg/m(2) significantly increases the risk. Obese individuals should be referred to a bariatric weight-loss center before their BMI reaches a threshold for OIL and MLL to develop. (J Am Coll Surg 2017; 224: 212-216. (C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)