首页 > 资讯 > Nature：肥胖对腿部慢性水肿/淋巴水肿的影响——一项国际多中心横断面研究（LIMPRINT）

Nature：肥胖对腿部慢性水肿/淋巴水肿的影响——一项国际多中心横断面研究（LIMPRINT）

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2024-12-18 17:53

AbstractBackground/ObjectivesObesity and chronic oedema/lymphoedema are two distinct but related conditions, rarely investigated together. The aim was to study the impact of increased weight on chronic oedema and related factors.Subjects/MethodsA cross-sectional study, 38 centers, nine countries. Patients with clinically confirmed chronic oedema/lymphoedema of the leg were included.

摘要背景/目的肥胖和慢性水肿/淋巴水肿是两种不同但相关的疾病，很少一起研究。目的是研究体重增加对慢性水肿和相关因素的影响。受试者/方法一项横断面研究，来自9个国家的38个中心。包括临床确诊为腿部慢性水肿/淋巴水肿的患者。

Weight category was estimated as: normal weight (BMI 20–30), class I-II obesity (BMI 30–40), or class III obesity (BMI > 40). Factors were tested for an association with increased weight, using a multivariable model.ResultsA total of 7397 patients were included; 43% with normal weight, 36% class I-II obesity and 21% class III obesity.

体重类别估计为：正常体重（BMI 20-30），I-II类肥胖（BMI 30-40）或III类肥胖（BMI>40）。使用多变量模型测试因素与体重增加的关联。结果共纳入7397例患者；正常体重为43%，I-II级肥胖为36%，III级肥胖为21%。

Increased weight was associated with more advanced stages of chronic oedema (ISL stage III; the most advanced form); affecting 14% in normal weight, 18% class I-II obesity and 39% class III obesity (p < 0.001). Ten factors were independently associated with increased weight: diabetes (OR 2.4), secondary lymphoedema (OR 2.7), cellulitis/erysipelas within 12 months (OR 1.2), bilateral lymphoedema (OR 3.6), compression therapy (OR 2.1), increased swelling duration (1–2 years OR 1.3, 2–5 years OR 2.5, 5–10 years OR 3.6, >10 years OR 3.5) decreased mobility (walking with aid OR 1.9, being chair bound OR 1.2) and age (reference<45 years; 45–64 years OR 1.5, 75–84 years OR 0.6, 85+ years OR 0.2).

体重增加与慢性水肿的晚期阶段（ISL III期；最晚期形式）有关；影响正常体重的14%，I-II类肥胖的18%和III类肥胖的39%（p<0.001）。十个因素与体重增加独立相关：糖尿病（OR 2.4），继发性淋巴水肿（OR 2.7），12个月内蜂窝织炎/丹毒（OR 1.2），双侧淋巴水肿（OR 3.6），压迫疗法（OR 2.1），肿胀持续时间增加（1-2年或1.3,2-5年或2.5,5-10年或3.6，>10年或3.5）活动能力下降（辅助行走OR 1.9，坐在椅子上OR 1.2）和年龄（参考<45岁；45-64岁或1.5,75-84岁或0.6,85岁以上或0.2））。

Increased weight was associated with a lower presentation of peripheral arterial disease (OR 0.7) and poorer chronic oedema control (OR 0.8). Patients with obesity had lower function, appearance and more severe symptoms (LYMQOL) and lower quality of life (EuroQol).ConclusionsObesity negatively impacts chronic oedema, leading to more advanced stages.

体重增加与外周动脉疾病的表现较低（OR 0.7）和慢性水肿控制较差（OR 0.8）有关。肥胖患者的功能，外观和症状较低（LYMQOL），生活质量较低（EuroQol）。结论肥胖对慢性水肿产生负面影响，导致更晚期。

Achieving good control of .

实现对的良好控制。

IntroductionThe increasing prevalence of obesity and related comorbidities is draining health care resources across the world. Numerous comorbidities are associated with obesity including type 2 diabetes, hypertension, cardiovascular diseases and sleeping disorders [1]. Lately, obesity has been recognized as a cause of lymphoedema/chronic oedema [2,3,4] with a significant overrepresentation of lymphoedema in patients with obesity [5].

引言肥胖和相关合并症的日益流行正在消耗世界各地的医疗保健资源。许多合并症与肥胖有关，包括2型糖尿病、高血压、心血管疾病和睡眠障碍（1）。最近，肥胖被认为是淋巴水肿/慢性水肿的原因[2，3，4]，肥胖患者的淋巴水肿明显过多[5]。

In a study of 330 patients with severe obesity 33% had a lymphoedema-like swelling [6].Lymphoedema is a disease caused by either developmental issues (primary) or a destruction of the lymphatic system (secondary), e.g. by cancer obstruction/surgery, venous insufficiency, parasitic nematodes filariasis [7] or obesity.

在一项针对330名严重肥胖患者的研究中，33%患有淋巴水肿样肿胀（6）。淋巴水肿是由发育问题（原发性）或淋巴系统破坏（继发性）引起的疾病，例如癌症阻塞/手术，静脉功能不全，寄生线虫丝虫病或肥胖。

More than one cause of lymphoedema can be found [8] and other factors such as cardiac and/or renal insufficiency can also contribute to the oedema development. For this reason, the umbrella term chronic oedema has been introduced (oedema >3 months). Irrespective of the cause, these conditions lead to soft-tissue swelling, increasing the risk of bacterial cellulitis, movement restriction, functional loss, and reduced quality of life [7].

淋巴水肿的原因不止一种，其他因素如心脏和/或肾功能不全也可能导致水肿的发展。因此，引入了总称慢性水肿（水肿>3个月）。无论原因如何，这些情况都会导致软组织肿胀，增加细菌性蜂窝织炎，运动受限，功能丧失和生活质量下降的风险（7）。

The stagnant lymphatic fluid in lymphoedema initiates an inflammatory response with T cell activation, and induction of Th2 cytokines IL-4 and Il-13 that along with TGF-β1 contribute to increased lymphatic leakiness, decreased lymphatic pumping and fibrosis development [9]. This is reflected clinically; in the initial phases, a soft swelling is developed with pitting oedema, and with time fibrosis, hyperkeratosis, dermal thickening and warty overgrowths develop, including fat tissue deposition [10, 11].

淋巴水肿中停滞的淋巴液通过T细胞活化引发炎症反应，诱导Th2细胞因子IL-4和IL-13与TGF-β1一起导致淋巴漏增加，淋巴泵减少和纤维化发展。这在临床上得到了反映；在初始阶段，软肿胀发展为点状水肿，随着时间的推移，纤维化，角化过度，皮肤增厚和疣状过度生长，包括脂肪组织沉积[10，11]。

The stimulation of the adipogenesis in lymphoedema has been proven both in humans and animal.

淋巴水肿中脂肪生成的刺激已在人类和动物中得到证实。

All data generated or analyzed during this study are included in this published article.

本研究期间生成或分析的所有数据均包含在本文中。

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Download referencesAcknowledgementsThe authors are grateful to all the patients and colleagues from 38 centers who contributed to the study.FundingThe LIMPRINT project was funded by the charity International Lymphoedema Framework and the medical device company 3 M Healthcare, providing an unrestricted grant.

下载参考文献致谢作者感谢来自38个中心的所有患者和同事为这项研究做出了贡献。资助LIMPRINT项目由慈善国际淋巴水肿框架和医疗器械公司3M Healthcare资助，提供不受限制的赠款。

3 M Healthcare had no role in the study design, data collection, data analysis, data interpretation, writing or decision to submit the article for publication. All authors and researchers acted independently from funders. Open access funding provided by Copenhagen University.Author informationAuthors and AffiliationsDepartment of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, DenmarkEwa Anna Burian, Tonny Karlsmark, Susan Nørregaard & Christine Joy MoffattSteno Diabetes Center Copenhagen, Herlev, DenmarkJørgen RungbyPianeta Linfedema Study Centre, Terni, ItalyMarina CestariCentre for Research and Implementation of Clinical Practice, London, United KingdomPeter J.

3M Healthcare在研究设计，数据收集，数据分析，数据解释，写作或决定提交文章发表方面没有任何作用。所有作者和研究人员都独立于资助者行事。哥本哈根大学提供的开放获取资金。作者信息作者和附属机构哥本哈根大学医院比斯佩比耶格医院皮肤性病与伤口愈合中心，哥本哈根，登马克瓦·安娜·布里安，托尼·卡尔斯马克，苏珊·恩雷加德和克里斯蒂娜·乔伊·莫法特斯特诺糖尿病中心哥本哈根，赫尔列夫，登马克约尔根·伦比·皮亚内塔·林费德马研究中心，特尼，意大利伊斯塔里中心临床实践研究与实施，伦敦，联合王国彼得·J。

Franks & Christine Joy MoffattNottingham University Hospitals NHS Trust, Nottingham, United KingdomChristine Joy MoffattAuthorsEwa Anna BurianView author publicationsYou can also search for this author in.

Franks&Christine Joy Moffattingham University Hospitals NHS Trust，Nottingham，United KingdomChristine Joy MoffattAuthorsEwa Anna BurianView作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarJørgen RungbyView author publicationsYou can also search for this author in

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PubMed Google ScholarTonny KarlsmarkView author publicationsYou can also search for this author in

PubMed Google ScholarTonny KarlsmarkView作者出版物您也可以在

PubMed Google ScholarSusan NørregaardView author publicationsYou can also search for this author in

PubMed Google ScholarSusan NørregaardView作者出版物您也可以在

PubMed Google ScholarMarina CestariView author publicationsYou can also search for this author in

PubMed Google ScholarMarina CestariView作者出版物您也可以在

PubMed Google ScholarPeter J. FranksView author publicationsYou can also search for this author in

PubMed Google ScholarPeter J.FranksView作者出版物您也可以在

PubMed Google ScholarChristine Joy MoffattView author publicationsYou can also search for this author in

PubMed Google ScholarChristine Joy MoffattView作者出版物您也可以在

PubMed Google ScholarContributionsEwa A. Burian: Writing - Original Draft, Writing - Review & Editing, Formal analysis. Peter J. Franks: Methodology, Data Curation, Formal analysis, Writing - Review & Editing. Susan Nørregaard: Methodology, Investigation, Writing - Review & Editing.

PubMed谷歌学术贡献Sewa A.Burian：写作-原稿，写作-评论和编辑，形式分析。Peter J.Franks：方法论，数据管理，形式分析，写作-评论和编辑。苏珊·恩雷加德：方法论，调查，写作-评论和编辑。

Tonny Karlsmark: Methodology, Investigation, Writing - Review & Editing. Marina Cestari: Investigation, Writing - Review & Editing. Jørgen Rungby: Writing - Review & Editing. Christine J. Moffatt: Conceptualization, Project administration, Methodology, Investigation, Writing - Review & Editing. All authors contributed to interpretation of data and approved the final version of the manuscript.Corresponding authorCorrespondence to.

托尼·卡尔斯马克：方法论，调查，写作-评论和编辑。玛丽娜·塞斯塔里：调查、写作、评论和编辑。Jørgen Rungby：写作-评论和编辑。克里斯汀·J·莫法特：概念化，项目管理，方法论，调查，写作-评论和编辑。所有作者都为数据的解释做出了贡献，并批准了手稿的最终版本。对应作者对应。

Ewa Anna Burian.Ethics declarations

伊娃·安娜·布里安。道德宣言

Competing interests

相互竞争的利益

EAB has been sponsored by ILF and the Ellab-Fonden (charities) for work on different lymphoedema-related research, payments made to the department. EAB has previously been a lecturer for Medi. JR, TK and MC have no conflicts related to this work. PJF has received grants from Tactile Medical through his employer (CRICP), and is sponsored by ILF.

EAB由ILF和Ellab Fonden（慈善机构）赞助，从事与淋巴水肿相关的不同研究，并向该部门支付了费用。EAB之前是Medi的讲师。。

CJM was sponsored by Thuasne and Essity Healthcare for consulting in compression therapy, and by ILF for work on different research. The authors regard none of the listed potential conflicts of interest to have influenced the results or interpretation of data..

CJM由Thuasne和Essity Healthcare赞助，用于压缩疗法的咨询，由ILF赞助，用于不同的研究。作者认为，列出的潜在利益冲突均未影响数据的结果或解释。。

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Reprints and permissionsAbout this articleCite this articleBurian, E.A., Rungby, J., Karlsmark, T. et al. The impact of obesity on chronic oedema/lymphoedema of the leg – an international multicenter cross-sectional study (LIMPRINT).

转载和许可本文引用本文Burian，E.A.，Rungby，J.，Karlsmark，T。等人。肥胖对腿部慢性水肿/淋巴水肿的影响-一项国际多中心横断面研究（LIMPRINT）。

Int J Obes (2024). https://doi.org/10.1038/s41366-024-01544-0Download citationReceived: 26 September 2023Revised: 08 May 2024Accepted: 13 May 2024Published: 03 July 2024DOI: https://doi.org/10.1038/s41366-024-01544-0Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Int J Obes（2024年）。https://doi.org/10.1038/s41366-024-01544-0Download引文接收日期：2023年9月26日修订日期：2024年5月8日接受日期：2024年5月13日发布日期：2024年7月3日OI：https://doi.org/10.1038/s41366-024-01544-0Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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