Department of Vascular Surgery, Central Clinical Hospital of Internal Affairs, Warsaw, Poland.
Department of Applied Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland.
Lymphat Res Biol. 2021 Dec;19(6):545-552. doi: 10.1089/lrb.2020.0051. Epub 2021 Feb 15.
The lymphedema-affected limbs are predisposed to acute and, subsequently, chronic dermato-lymphangio-adenitis (DLA) episodes in around 40%-50% of cases, irrespective of what the primary etiological factor is for the development of this condition. DLA is of bacterial etiology, and it needs antibiotic control and prevention of recurrence. Our aim was to follow the effects of years-long continuous no-break administration of benzathine penicillin on the recurrence of acute DLA episodes. Two hundred thirty-one patients were affected with lymphedema of lower and upper limbs. The mean duration of lymphedema was 10.2 ± 7.3 (range 2-30) years, and the number of DLA attacks/patient was 3.3 ± 3.2 (range 1-10). The total number of DLA episodes was 805. Benzathine penicillin injections 1,200,000 units were given i.m. at 14-21 days intervals (mean 18 ± 9 days) with short accidental breaks only. The period of therapy was 39.2 ± 38.7 (median 32) months. Recurrence occurred in 23 out of 231 (10%) ( < 0.01). There were 42 DLA incidents compared with 805 before introduction of therapy (5.2%) patients (hazard ratio 0.05, 95% confidence interval 0.034-0.079) ( < 0.01). Among patients with recurrence, there was a decrease of DLA episodes from 6.2% ± 3.6% to 1.7% ± 1.0%/patient. There were no differences in effectiveness of penicillin prophylaxis between etiological groups, depending on stages of lymphedema. Long-term years-long benzathine penicillin prophylaxis is extremely effective in prevention of DLA recurrence. It can be applied for years with no breaks, without clinical side-effects, and raising resistance to antibiotics. Microbial colonization and evoked inflammatory reaction of hosts should be controlled from the first symptoms of lymph stasis, irrespective of the etiology of lymphedema.
淋巴水肿受累肢体易发生急性，随后发生慢性皮肤淋巴管-腺炎（DLA）发作，在大约 40%-50%的病例中，无论引起该疾病的主要病因是什么。DLA 是细菌性病因，需要抗生素控制和预防复发。我们的目的是观察多年连续不间断使用苄星青霉素对急性 DLA 发作复发的影响。231 例患者患有下肢和上肢淋巴水肿。淋巴水肿的平均持续时间为 10.2±7.3 年（范围 2-30 年），每位患者的 DLA 发作次数为 3.3±3.2（范围 1-10）。DLA 发作总数为 805 次。每隔 14-21 天（平均 18±9 天）肌内注射 120 万单位苄星青霉素，仅偶然短暂中断。治疗期为 39.2±38.7 个月（中位数 32 个月）。231 例患者中有 23 例（10%）（<0.01）复发。与治疗前的 805 例相比，DLA 发生率为 42 例（5.2%）（危险比 0.05，95%置信区间 0.034-0.079）（<0.01）。在复发的患者中，DLA 发作次数从 6.2%±3.6%降至 1.7%±1.0%/患者。根据淋巴水肿的分期，青霉素预防在不同病因组之间的效果无差异。长期多年的苄星青霉素预防治疗对预防 DLA 复发非常有效。可以连续多年应用，无需中断，无临床副作用，且提高抗生素耐药性。应从淋巴淤滞的最初症状开始控制微生物定植和宿主引发的炎症反应，而不考虑淋巴水肿的病因。
