Development of a novel method of assessing lymph function in human extremities and its clinical application

淋巴运输至少在一定程度上是由淋巴管的内在泵送控制的。虽然了解这一过程对医学应用很重要，但由于难以测量，目前所知甚少。在这里，我们介绍一种简单、安全、经济的方法来测量腿部浅淋巴管的淋巴泵送。我们比较了用这种技术获得的读数和用动态淋巴显像获得的值，动态淋巴显像是一种更困难和昂贵的技术。此外，我们研究了健康患者和淋巴水肿患者之间淋巴泵送的差异。在足背皮下注射0.3 ml (0.5%) ICG荧光淋巴造影术。在仰卧或坐位时，利用红外线摄像系统获得淋巴推进的实时荧光图像。一个定制的透明血压计袖带包裹在底部，并连接到一个标准的水银血压计。将袖带充气至60 mm Hg，然后每隔5分钟逐渐放气，以10 mm Hg的步骤降低压力，直到荧光染料超过袖带的上边界（表明淋巴收缩已经克服了袖带压力）。淋巴泵压（Ppump）定义为染料超过袖带上边界时的袖带压力值。在健康、仰卧的受试者中，泵为25.2±16.7 mm Hg （mean±SD）。健康组（Ppump = 29.3±16.0）高于淋巴水肿组（Ppump = 13.2±14.9）。我们测量淋巴泵送的方法可能会发展成为诊断淋巴功能障碍的重要工具。目的探讨年龄、性别对下肢淋巴泵压的影响。共有399名年龄在20 - 91岁之间的受试者自愿参加本研究，其中男性199人，女性200人。在399名参与者的798条腿上测量了淋巴泵。采用吲哚菁绿（ICG）荧光淋巴造影，利用红外摄像系统获得坐位时淋巴推进的实时荧光图像。一个定制的透明血压计袖带包裹在小腿上，并连接到标准的水银血压计。袖口充气，然后逐渐放气，直到荧光染料超过袖口的上边缘。淋巴泵压定义为染色液超过袖带上缘时的袖带压力值。腿部淋巴泵送与年龄有显著相关性：r = -0.34 （p < 0.0001）。男女淋巴泵压的比较表明，年龄相关的淋巴泵压下降在绝经后年龄的女性中更为明显。少

Lymph transportation is controlled, at least in part, by the intrinsic pumping of lymphatic vessels. Although an understanding of this process is important for medical application, little is currently known because it is difficult to measure. Here, weintroduce an easy, safe, and cost-effective technique for measuring lymphatic pumping in leg superficial lymphatic vessels. We compared readings obtained with this technique with values obtained by performing dynamic lymphoscintigraphy, a more difficult and expensive technique. Further, we investigated differences in lymphatic pumping between healthy patients and patients with lymphedema. Indocyanine green (ICG) fluorescence lymphography was performed by subcutaneously injecting 0.3 ml of ICG (0.5%) into the dorsum of the foot. Real-time fluorescence images of lymph propulsion were obtained with an infrared-light camera system in a supine or a sitting position. A custom-made transparent sphygmomanometer cuff was wrapped around the lower le … More g and connected to a standard mercury sphygmomanometer. The cuff was inflated to 60 mm Hg, then gradually deflated at 5-min intervals to lower the pressure by 10 mm Hg steps until the fluorescence dye exceeded the upper border of the cuff (indicating that the lymphatic contraction had overcome the cuff pressure). Lymph pumping pressure (Ppump) was defined as the value of the cuff pressure when the dye exceeded the upper border of the cuff. Among healthy, supine subjects, Ppump was 25.2 ± 16.7 mm Hg (mean ± SD). Healthy subjects (Ppump = 29.3 ± 16.0) showed higher Ppumthan those for lymphedematous subjects (13.2 ± 14.9). Our method of measuring lymphatic pumping may develop as a vital tool for diagnosing lymphatic malfunctions.T o evaluate the influences of age and gender on leg lymphatic pumping pressure. A total of 399 subjects between the ages of 20 and 91 years (199 males and 200 females) volunteered to participate in this study. Lymphatic pumping was measured in 798 legs of the 399 participants. Indocyanine green (ICG) fluorescence lymphography was performed, and the real-time fluorescence images of lymph propulsion were obtainedin a sitting position using an infrared-light camera system. A custom-made transparent sphygmomanometer cuff was wrapped around the lower leg and connected to astandard mercury sphygmomanometer. The cuff was inflated, and then gradually deflated until the fluorescent dye exceeded the upper border of the cuff. Lymph pumping pressure was defined as the value of the cuff pressure when the dye exceeded the upper border of the cuff. There was a significant correlation between the leg lymphatic pumping and age: r = -0.34 (p < 0.0001). Comparison of lymphatic pumping between males and females indicated that the age-related decrease in lymphatic pumping pressure was more marked in females of postmenopausal age. Less