Badger Caroline M A, Preston Nancy J, Seers Kate, Mortimer Peter S
Institute Research Team, Royal College of Nursing Institute, RCN Institute, 20 Cavendish Square, London, UK, W1M 0AB.
Cochrane Database Syst Rev. 2009 Jan 21(1):CD003143. doi: 10.1002/14651858.CD003143.pub3.
Lymphoedema is a chronic, progressive condition and one area of debate is the optimum management for infective/inflammatory episodes (AIE's).
To determine whether antibiotic/anti-inflammatory drugs given prophylactically reduce the number and severity of AIE's in patients with lymphoedema.
We searched the Cochrane Breast Cancer Group register in September 2003, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), CINAHL, MEDLINE, PASCAL, SIGLE, UnCover, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and the International Society of Lymphology congress proceedings.
Randomised controlled trials testing an antibiotic or anti-inflammatory drug against placebo (with or without physical therapies) were included.
Eligibility for inclusion was confirmed by two blinded reviewers. The papers were screened independently using a checklist of criteria relating to quality. Both reviewers extracted data from the eligible studies using a data extraction form.
Four studies (364 randomised patients) were included. Two studied the effects of intensive physical treatment plus selenium or placebo in preventing AIE's, and two studied the effects of Ivermectin, Diethylcarbamazine (DEC) (anti-filarial agents) and penicillin as prophylactic treatment for adeno lymphangitis(ADL) versus placebo.Both selenium trials reported no inflammatory episodes during the trial period in the treated group but one case of infection in the two placebo groups respectively. Seven additional cases of infection in trial one and 14 cases in trial two required treatment in the three month follow up period.One anti-filarial trial reported 127 ADL episodes for all groups during the treatment year (compared with 684 episodes during the pre-treatment year). There were 228 ADL episodes during the trial follow-up year but no findings were significant. No link was found between the grade of oedema and the frequency of ADL episodes. There was a significant link between increased episodes and the rainy season. Penicillin reduced the mean number of inflammatory episodes from 4.6 to 0.5 after treatment, which increased to 1.9 at the end of follow-up.
AUTHORS' CONCLUSIONS: The effectiveness of selenium in preventing AIE in lymphoedema remains inconclusive in the absence of properly conducted randomised-controlled trials. Anti-filarials do not appear to reduce ADL episodes in filarial lymphoedema. Penicillin appears to contribute to a significant reduction in ADL when combined with foot-care. The importance of foot-care should be recommended, which may also apply to care of the arm following breast cancer treatment. Properly conducted trials are needed to demonstrate any efficacy of these interventions.
淋巴水肿是一种慢性进行性疾病，关于感染性/炎症性发作（AIE）的最佳管理是一个存在争议的领域。
确定预防性给予抗生素/抗炎药物是否能减少淋巴水肿患者AIE的发作次数和严重程度。
我们检索了2003年9月的Cochrane乳腺癌组登记册、Cochrane对照试验中央登记册（《Cochrane图书馆》，2003年第4期）、CINAHL、MEDLINE、PASCAL、SIGLE、UnCover、英国淋巴学会编制的参考文献列表、国家研究登记册（NRR）以及国际淋巴学会大会论文集。
纳入对比抗生素或抗炎药物与安慰剂（有无物理治疗）的随机对照试验。
两名盲法评审员确认纳入资格。使用与质量相关的标准清单独立筛选论文。两位评审员均使用数据提取表从符合条件的研究中提取数据。
纳入四项研究（364例随机分组患者）。两项研究了强化物理治疗加硒或安慰剂预防AIE的效果，两项研究了伊维菌素、乙胺嗪（DEC）（抗丝虫药）和青霉素作为腺淋巴管炎（ADL）预防性治疗与安慰剂的效果。两项硒试验均报告治疗组在试验期间无炎症发作，但两个安慰剂组分别有1例感染。在三个月的随访期内，试验一中另外有7例感染病例，试验二中有14例感染病例需要治疗。一项抗丝虫试验报告治疗年度所有组共有127次ADL发作（治疗前一年为6旦4次发作）。试验随访年度有228次ADL发作，但无显著结果。未发现水肿程度与ADL发作频率之间存在关联。发作次数增加与雨季之间存在显著关联。青霉素治疗后炎症发作的平均次数从4.6次降至0.5次，随访结束时增至1.9次。
在缺乏恰当实施的随机对照试验的情况下，硒预防淋巴水肿中AIE的有效性仍不确定。抗丝虫药似乎不能减少丝虫性淋巴水肿中的ADL发作。青霉素与足部护理联合使用似乎能显著减少ADL发作。应推荐足部护理的重要性，这可能也适用于乳腺癌治疗后手臂的护理。需要恰当实施试验来证明这些干预措施的任何疗效。
