From the Department of Plastic and Oral Surgery and the Lymphedema Program, and the Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2020 Aug;146(2):402-407. doi: 10.1097/PRS.0000000000007021.
Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition.
Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m); and group 2, obese (body mass index ≥30 kg/m). Inclusion criteria were patients aged 21 years or older with lymphedema confirmed by lymphoscintigraphy. Covariates included age, sex, lymphedema type (primary or secondary), location, comorbidities, lymph node dissection, radiation therapy, lymphoscintigram result, and disease duration. Outcome variables were infection, hospitalization, and degree of limb overgrowth. The cohorts were compared using the Mann-Whitney U test, Fisher's exact test, and multivariable logistic regression.
Sixty-seven patients were included: group 1, n = 33; and group 2, n = 34. Disease duration did not differ between groups (p = 0.72). Group 2 was more likely to have an infection (59 percent), hospitalization (47 percent), and moderate or severe overgrowth (79 percent), compared to group 1 (18, 6, and 40 percent, respectively; p < 0.001). Multivariable logistic regression showed that obesity was an independent risk factor for infection (OR, 7.9; 95 percent CI, 2.5 to 26.3; p < 0.001), hospitalization (OR, 30.0; 95 percent CI, 3.6 to 150.8; p < 0.001), and moderate to severe limb overgrowth (OR, 6.7; 95 percent CI, 2.1 to 23.0; p = 0.003).
Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
肥胖是腋窝淋巴结清扫和放射治疗后继发淋巴水肿的一个危险因素。本研究的目的是确定肥胖是否会影响患有该病患者的淋巴水肿发病率。
比较了两组患者：第 1 组为正常体重（体重指数≤25kg/m）；第 2 组为肥胖（体重指数≥30kg/m）。纳入标准为年龄≥21 岁且经淋巴闪烁显像证实患有淋巴水肿的患者。协变量包括年龄、性别、淋巴水肿类型（原发性或继发性）、部位、合并症、淋巴结清扫术、放射治疗、淋巴闪烁显像结果和疾病持续时间。结局变量为感染、住院和肢体过度生长程度。使用 Mann-Whitney U 检验、Fisher 确切检验和多变量逻辑回归比较两组。
共纳入 67 例患者：第 1 组，n=33；第 2 组，n=34。两组疾病持续时间无差异（p=0.72）。与第 1 组（18%、6%和 40%）相比，第 2 组更易发生感染（59%）、住院（47%）和中度或重度过度生长（79%）（p<0.001）。多变量逻辑回归显示，肥胖是感染（OR，7.9；95%CI，2.5 至 26.3；p<0.001）、住院（OR，30.0；95%CI，3.6 至 150.8；p<0.001）和中重度肢体过度生长（OR，6.7；95%CI，2.1 至 23.0；p=0.003）的独立危险因素。
肥胖会对已确诊的淋巴水肿患者产生负面影响。与体重指数正常的患者相比，肥胖患者更易发生感染、住院和更大的肢体。应向患有淋巴水肿的患者提供有关肥胖对其病情影响的咨询。
临床问题/证据水平：风险，II 级。
