Douglass Janet, Graves Patricia, Gordon Susan
1 Division of Tropical Medicine, James Cook University , Queensland, Australia .
2 Flinders University , School of Health Sciences, Bedford Park, South Australia .
Lymphat Res Biol. 2017 Mar;15(1):57-63. doi: 10.1089/lrb.2016.0021. Epub 2016 Sep 27.
Measurements of tissue compressibility and extracellular fluid (ECF) are used to monitor progression of lymphedema, a chronic swelling of the subcutaneous tissue. Later stages of lymphedema are characterized by fibrotic induration in the subcutis and hyperkeratosis of the skin. Several devices are available to measure these changes, but previous reliability and validity studies have been conducted primarily on adult women with unilateral arm lymphedema using contralateral limbs as controls. To date, no studies have included either adolescents or measurement of leg tissue.
An intrarater reliability study was conducted to compare three devices measuring skin and subcutaneous tissue compressibility; a mechanical Tonometer, a digital Indurometer, and a SkinFibroMeter. ECF loads were measured using bioimpedance spectroscopy (BIS). Two populations of tropical-dwelling young people were included; Australian residents in North Queensland aged 8-21 years (n = 34) and people aged 10-21 years residing in Central Myanmar (n = 38). Neither cohort had any clinical sign of lymphedema or other leg abnormality. The mechanical Tonometer and the digital Indurometer had excellent intraclass correlation coefficient (ICC) scores between 0.792 (95% CI 0.055-0.901) and 0.964 (95% CI 0.945-0.984) and the SkinFibroMeter had good to excellent reliability with ICC scores of between 0.565 (95% CI 0.384-0.747) and 0.877 (95% CI 0.815-0.840). BIS exhibited the highest reliability with ICC scores approaching 1.0.
These results support the reliable use of tonometry and BIS to assess tissue compressibility and ECF loads in the legs of adolescent populations in developed and developing tropical countries.
组织压缩性和细胞外液（ECF）的测量用于监测淋巴水肿的进展，淋巴水肿是皮下组织的一种慢性肿胀。淋巴水肿的后期阶段表现为皮下组织的纤维化硬结和皮肤的角化过度。有几种设备可用于测量这些变化，但之前的可靠性和有效性研究主要是在患有单侧手臂淋巴水肿的成年女性中进行的，使用对侧肢体作为对照。迄今为止，尚无研究纳入青少年或测量腿部组织。
进行了一项评估者内可靠性研究，以比较三种测量皮肤和皮下组织压缩性的设备；一种机械眼压计、一种数字硬度计和一种皮肤纤维测定仪。使用生物电阻抗光谱法（BIS）测量ECF负荷。纳入了两组居住在热带地区的年轻人；北昆士兰年龄在8 - 21岁的澳大利亚居民（n = 34）和居住在缅甸中部年龄在10 - 21岁的人群（n = 38）。两组均无淋巴水肿或其他腿部异常的临床体征。机械眼压计和数字硬度计的组内相关系数（ICC）得分极佳，在0.792（95%CI 0.055 - 0.901）和0.964（95%CI 0.945 - 0.984）之间，皮肤纤维测定仪的可靠性良好至极佳，ICC得分在0.565（95%CI 0.384 - 0.747）和0.877（95%CI 0.815 - 0.840）之间。BIS的可靠性最高，ICC得分接近1.0。
这些结果支持可靠地使用眼压测量法和BIS来评估发达国家和发展中热带国家青少年腿部的组织压缩性和ECF负荷。
