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

淋巴转运至少部分地由淋巴管的内在泵送控制。虽然了解这一过程对医学应用很重要，但由于难以测量，目前知之甚少。在这里，我们介绍一种简单，安全，成本效益的技术来测量淋巴泵在腿部浅表淋巴管。我们将该技术获得的读数与动态淋巴结造影（一种更困难和昂贵的技术）获得的值进行了比较。此外，我们研究了健康患者和水肿患者之间的淋巴泵的差异。通过将0.3ml吲哚菁绿色（ICG）（0.5%）皮下注射到足背进行ICG荧光淋巴造影。实时荧光图像的淋巴推进获得了红外线照相机系统在仰卧位或坐位。一个定制的透明血压计袖带缠绕在下腿上， ...更多信息 g，并连接到标准水银血压计。将袖带充气至60 mm Hg，然后以5 min间隔逐渐放气，以10 mm Hg的步长降低压力，直到荧光染料超过袖带的上边界（表明淋巴收缩已克服袖带压力）。淋巴泵压（P泵）定义为染料超过袖带上边界时的袖带压力值。在健康仰卧位受试者中，P泵为25.2 ± 16.7 mm Hg（平均值±标准差）。健康人的Ppump（29.3 ± 16.0）高于水肿病人的Ppump（13.2 ± 14.9）。本研究所建立的淋巴泵压测定方法可作为诊断淋巴功能障碍的重要工具，并可评价年龄和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（199名男性和200名女性）自愿参加本研究。在399名参与者的798条腿上测量了淋巴泵。采用吲哚菁绿色（ICG）荧光淋巴造影技术，采用红外线摄像系统，在坐位上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缠绕在小腿上，并连接到一个标准的水银血压计。对袖带充气，然后逐渐放气，直到荧光染料超过袖带的上边界。淋巴泵压定义为染料超过袖带上边界时的袖带压力值。下肢淋巴泵量与年龄呈显著相关：r = -0.34（p < 0.0001）。男性和女性之间的淋巴泵压的比较表明，年龄相关的淋巴泵压的下降在绝经后年龄的女性更显着。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