Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea.
Lymphat Res Biol. 2024 Oct;22(5):241-247. doi: 10.1089/lrb.2023.0021. Epub 2024 Sep 4.
Complex decongestive therapy (CDT) is being used in breast cancer-related lymphedema (BCRL). The degree of initial edema and bioimpedance analysis (BIA) are known to be related with the therapeutic effect of CDT. D-dimer can indirectly reflect lymphangiogenesis because IL-6 regulates D-dimer and vascular endothelial growth factor, which is the most important lymphangiogenic factor. We assessed whether D-dimer could be used for the prediction of therapeutic effect of CDT, as well as BIA and initial edema. The participants were patients who took inpatient treatment for BCRL from July 2016 to May 2020. Percent excess volume (PEV) was calculated by dividing the difference in volume of both arms by the edema arm, and the difference in PEV before and after 2 weeks of CDT was defined as the CDT effect. BIA and D-dimer tests were performed before treatment. The single frequency bioimpedance analysis (SFBIA) ratio and D-dimer showed significant correlations with β coefficients of 0.581 and 0.402 ( < 0.01), respectively, and the explanatory power of these models was confirmed to be 0.704.The areas under the curve of initial PEV, SFBIA ratio, D-dimer for determining the CDT effect were identified as 0.849, 0.795, and 0.725, respectively. Initial PEV, SFBIA ratio, and blood D-dimer levels could be used as predictors for CDT treatment effect. Their usefulness order was in the order of initial PEV, SFBIA ratio, and D-dimer. These factors could be used as predictors to establish therapeutic plan in patients with mild lymphedema.
在乳腺癌相关淋巴水肿（BCRL）中应用了复杂消肿治疗（CDT）。初始水肿程度和生物阻抗分析（BIA）已知与 CDT 的治疗效果有关。D-二聚体可以间接反映淋巴管生成，因为白细胞介素 6 调节 D-二聚体和血管内皮生长因子，后者是最重要的淋巴管生成因子。我们评估了 D-二聚体是否可用于预测 CDT 的治疗效果，以及 BIA 和初始水肿。参与者为 2016 年 7 月至 2020 年 5 月接受 BCRL 住院治疗的患者。通过将双臂之间的体积差异除以水肿臂的体积来计算多余百分比（PEV），并将 CDT 治疗前 2 周和后 2 周的 PEV 差异定义为 CDT 效果。在治疗前进行 BIA 和 D-二聚体测试。单频生物阻抗分析（SFBIA）比值和 D-二聚体与β系数分别具有显著相关性，相关系数为 0.581 和 0.402（<0.01），并且证实这些模型的解释能力为 0.704。用于确定 CDT 效果的初始 PEV、SFBIA 比值和 D-二聚体的曲线下面积分别为 0.849、0.795 和 0.725。初始 PEV、SFBIA 比值和血液 D-二聚体水平可作为 CDT 治疗效果的预测指标。其有用性顺序为初始 PEV、SFBIA 比值和 D-二聚体。这些因素可用于预测轻度淋巴水肿患者的治疗计划。
