与手臂淋巴水肿蜂窝织炎相关的因素——一项国际横断面研究（LIMPRINT）。

Factors associated with cellulitis in lymphoedema of the arm - an international cross-sectional study (LIMPRINT).

机构信息

Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark.

Centre for Research and Implementation of Clinical Practice, London, UK.

出版信息

BMC Infect Dis. 2024 Jan 18;24(1):102. doi: 10.1186/s12879-023-08839-z.

DOI:10.1186/s12879-023-08839-z

PMID:38238718

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10797905/

Abstract

BACKGROUND

Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis.

METHODS

An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient's best interest were excluded. Both univariable and multivariable analysis were performed.

RESULTS

A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis.

CONCLUSION

Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.

摘要

背景

淋巴水肿是一个全球性的被忽视的医疗保健问题，也是乳腺癌治疗后的常见并发症。淋巴水肿是蜂窝织炎的一个已知的诱发因素，但很少有研究从国际层面探讨这种患者群体中蜂窝织炎的危险因素。本研究的目的是确定臂部淋巴水肿患者中蜂窝织炎的发生频率，包括其潜在的危险因素。

方法

这是一项国际性的、多中心的、横断面研究，纳入了临床评估臂部淋巴水肿的患者。主要结局是过去 12 个月内手臂淋巴水肿处发生蜂窝织炎的频率，以及其潜在的相关危险因素。次要结局是终生蜂窝织炎的患病率。纳入有临床评估的臂部淋巴水肿/慢性水肿（所有病因）且能知情同意的成年人。将临终患者或被判断为不符合患者最佳利益的患者排除在外。进行单变量和多变量分析。

结果

共纳入来自澳大利亚、丹麦、法国、爱尔兰、意大利、日本、土耳其和英国的 2160 名患者。继发性淋巴水肿见于 98%的患者；其中 95%的患者被判断为与癌症或其治疗有关。蜂窝织炎的终生患病率为 22%，1 年发病率为 11%。多变量分析后，与近期蜂窝织炎相关的因素是肿胀持续时间较长和淋巴水肿控制不佳。与淋巴水肿持续时间小于 1 年相比，风险随着时间的推移而增加：1-2 年（OR 2.15），2-5 年（OR 2.86），5-10 年（OR 3.15）。淋巴水肿控制良好的患者发生蜂窝织炎的风险降低 46%（OR 0.54，95%CI 0.39-0.73，p<0.001）。即使在调整肿胀持续时间和肿胀控制的情况下，淋巴水肿的更晚期阶段与蜂窝织炎相关（Ⅱ期 OR 5.44，Ⅲ期 OR 9.13，p=0.002），这在亚组分析中得到了证实。