Development of a Noninvasive Skin Evaluation Method for Lower Limb Lymphedema
Development of a Noninvasive Skin Evaluation Method for Lower Limb Lymphedema
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DOI：
10.1089/lrb.2018.0089
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发表时间：
2019-06-18
影响因子：
1.4
通讯作者：
Unno, Naoki
中科院分区：
文献类型：
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作者：
Sano, Masaki;Hirakawa, Satoshi;Unno, Naoki
背景：水肿患者的皮肤状况发生改变，评估这种变化是重要的。一些非侵入性的方法来评估皮肤状况，特别是在上肢水肿已被报道。然而，评估下肢水肿的皮肤仍然具有挑战性，并且通常仅限于触诊。我们的目的是开发一种无创的皮肤评估方法，下肢水肿患者。方法和结果：25例下肢水肿患者纳入研究。使用IDM 400和MPA 580测量皮肤硬结和弹性。分析了健康前臂和大腿皮肤的特性与患侧大腿皮肤的特性及年龄的关系。从前臂计算预测的皮肤硬化年龄（IA）和弹性年龄（EA），而从大腿计算实际值，并评估差异（Δ IA和Δ EA）。根据国际淋巴病学会临床分期系统对患者进行分类，并分析三组（健康、I/IIa期和IIb/III期）之间Delta IA和Delta EA的差异。对5例单侧下肢水肿患者进行皮肤活检，并采用Elastica货车Gieson染色，在显微镜下测定真皮弹性纤维面积。Delta EA随疾病进展显著增加，但Delta IA无显著变化。显微镜检查显示弹性纤维丝状变化，水肿影响皮肤的弹性纤维面积减少。结论：本研究首次对下肢皮肤弹性进行定量、无创性评价。Delta EA可用于评估水肿患者的皮肤状况进展。
Background: The skin's condition is altered in lymphedema patients, and evaluating this change is important. Some noninvasive methods for evaluating skin condition have been reported, especially in upper limb lymphedema. However, evaluating the skin in lower limb lymphedema remains challenging and is often limited to palpation. We aimed to develop a noninvasive skin evaluation method for lower limb lymphedema patients. Methods and Results: Twenty-five lower limb lymphedema patients were included. Skin induration and elasticity were measured using Indentometer (R) IDM 400 and Cutometer (R) MPA580. The relationship between the properties of skin from the healthy forearm and thigh, those of the affected thigh, and age was analyzed. Predicted skin induration age (IA) and elasticity age (EA) were calculated from the forearm, whereas actual values were calculated from the thigh, and the differences (Delta IA and Delta EA) were assessed. Patients were classified according to the International Society of Lymphology clinical staging system, and the differences in Delta IA and Delta EA were analyzed among the three groups (healthy, stage I/IIa, and stage IIb/III). Skin biopsy was performed in five unilateral lower limb lymphedema patients, and the dermal elastic fiber area was determined using microscopy with Elastica van Gieson staining. Delta EA significantly increased with disease progression, but Delta IA did not change significantly. Microscopy revealed elastic fiber filamentous changes, with decreased elastic fiber areas in lymphedema-affected skin. Conclusion: To our knowledge, this is the first report to evaluate lower limb skin elasticity in lymphedema quantitatively and noninvasively. Delta EA is useful for evaluating skin condition progression in lymphedema patients.