Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pennsylvania, USA.
Am J Phys Med Rehabil. 2011 Feb;90(2):89-96. doi: 10.1097/PHM.0b013e318201753e.
In the United States, there are more than 100,000 people with spina bifida. There have been very few studies to date documenting the occurrence of lymphedema in the spina bifida population, despite a case series in 2001 that suggested that the occurrence may be higher than in the general population. Currently, approximately 1 million people have lymphedema in the United States. The purpose of this study was to document the occurrence of lymphedema and associated medical factors in a regional adult spina bifida population.
A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January 2005 to August 2008 were retrospectively reviewed. Subjects were divided into two groups based on the presence or absence of lymphedema. χ² analyses were used to compare lymphedema groups with respect to history of medical comorbidities and ethnicity. Fisher exact tests were used to compare groups with respect to mobility status and the presence of power wheelchair seat functions. Mann-Whitney U tests were used to compare groups with respect to age, anatomic lesion level, employment level, and income.
Twenty-two (9.2%) patients had lymphedema. Mean ± SD population age was 35.1 ± 11.1 yrs. Lymphedema was associated with a history of trauma (P = 0.044), cellulitis (P < 0.001), cancer (P = 0.038), obesity (P < 0.001), wounds (P < 0.001), hypertension (P = 0.036), higher lesion level spina bifida (P = 0.049), and mobility status (P = 0.007). Hypertension and obesity were present in 38.3% and 37.5% of the total study population, respectively.
This is the first study to document the occurrence of lymphedema in a spina bifida patient population, which was almost 100 times higher than that in the general patient population. We also documented a high occurrence of hypertension and obesity in the total study population. These findings may help guide further prospective studies to more clearly delineate the risk factors for the development of lymphedema and to determine the appropriate therapies. Better screening, prevention and treatment algorithms are needed for hypertension and obesity in the spina bifida population.
在美国，有超过 10 万人患有脊柱裂。尽管 2001 年有一项病例系列研究表明，脊柱裂患者的发病率可能高于普通人群，但迄今为止，很少有研究记录脊柱裂患者的淋巴水肿发病情况。目前，美国约有 100 万人患有淋巴水肿。本研究的目的是记录一个区域性成人脊柱裂患者群体的淋巴水肿发病情况和相关医疗因素。
回顾性分析 2005 年 1 月至 2008 年 8 月成人脊柱裂诊所的 240 份电子病历。根据是否存在淋巴水肿，将受试者分为两组。χ²分析用于比较淋巴水肿组与医疗合并症和种族的关系。Fisher 确切检验用于比较移动状态和动力轮椅座位功能的组间差异。Mann-Whitney U 检验用于比较年龄、解剖病变水平、就业水平和收入的组间差异。
22 例（9.2%）患者有淋巴水肿。平均（SD）人群年龄为 35.1 ± 11.1 岁。淋巴水肿与创伤史（P = 0.044）、蜂窝织炎（P < 0.001）、癌症（P = 0.038）、肥胖症（P < 0.001）、伤口（P < 0.001）、高血压（P = 0.036）、更高水平的脊柱裂病变（P = 0.049）和移动状态（P = 0.007）相关。高血压和肥胖症在总研究人群中的患病率分别为 38.3%和 37.5%。
这是第一项记录脊柱裂患者淋巴水肿发病情况的研究，其发病率几乎是普通患者人群的 100 倍。我们还记录了总研究人群中高血压和肥胖症的高发病率。这些发现可能有助于指导进一步的前瞻性研究，更清楚地阐明淋巴水肿发展的危险因素，并确定适当的治疗方法。脊柱裂患者需要更好的高血压和肥胖症筛查、预防和治疗方案。
