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Phlebologie 2020; 49(01): 23-30
DOI: 10.1055/a-1096-3679
Originalarbeit

Prävalenz von Komorbiditäten bei Lymphödem-Erkrankungen

Prevalence of Comorbidities in Lymphedema
Anett Reißhauer
  Physikalische Medizin und Rehabilitation, Charité-Universitätsmedizin Berlin, Berlin
,
Leon Schuester
  Physikalische Medizin und Rehabilitation, Charité-Universitätsmedizin Berlin, Berlin
,
Annelies Kling
  Physikalische Medizin und Rehabilitation, Charité-Universitätsmedizin Berlin, Berlin
,
Max Emanuel Liebl
  Physikalische Medizin und Rehabilitation, Charité-Universitätsmedizin Berlin, Berlin
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Zusammenfassung

Hintergrund Komorbiditäten sind Erkrankungen, die nebeneinander auftreten, entweder voneinander unabhängig oder als Folgeerkrankung einer Indexerkrankung. Bekannte Ursachen oder Risikofaktoren für Lymphödeme (LÖ) sind u. a. maligne Erkrankungen und ihre Behandlung, Adipositas, chronisch-venöse Insuffizienz und das Lipödem. Bekannte Folgeerkrankungen sind u. a. Erysipele sowie Haut- und Nagelpilzerkrankungen. Ziel ist die Erhebung der Prävalenz von Komorbiditäten bei Lymphödem-Erkrankungen.

Methoden Retrospektive Analyse von 457 konsekutiven Fällen der Sprechstunde für Lymphödem-Erkrankungen der Hochschulambulanz einer Universitätsklinik hinsichtlich der Prävalenz von Komorbiditäten.

Ergebnisse n = 391 Fälle kamen zur Auswertung, getrennt nach Ödem-Genese, darunter n = 51 primäre Lymphödeme (pL) (Verdacht und gesichert, davon 8 gesicherte syndromale Erkrankungen) und n = 340 sekundäre Lymphödeme (sL). Das Geschlechterverhältnis in der Stichprobe war 9:1 (w:m). Während die pL-Patienten einen BMI vergleichbar der altersentsprechenden Referenzgruppe der Allgemeinbevölkerung aufwiesen, zeigten Patienten mit sL einen durchschnittlichen BMI von 33,8 und einen Anteil von 64 % adipöser Patienten (21 % mit BMI über 40). Die Prävalenz rezidivierender Erysipele war mit 7,8 bzw. 7,9 % zwischen pL und sL vergleichbar häufig. Weitere Prävalenzen wie Diagnosen aus dem muskuloskelettalen Bereich (ICD-Kapitel XIII/„M“) zeigten sich in der Stichprobe in altersgerechter Verteilung. Eine besonders hohe Prävalenz zeigten in der Gruppe der sL Schilddrüsenerkrankungen (30 %), dabei überwiegend die Schilddrüsenunterfunktion.

Diskussion Nur z. T. können das Patientenalter und Geschlecht die Prävalenzen der Komorbiditäten erklären. Auffällig beim sekundären LÖ ist die Prävalenz der Adipositas, die als Kofaktor bei der Entstehung und als aggravierender Faktor bekannt ist. Von Interesse ist auch die vergleichbare Prävalenz von Erysipelen zwischen den primären und sekundären Lymphödemen. Offenbar spielt die Genese des LÖ für die Entstehung eines Erysipels keine Rolle. Bislang kaum beschrieben, aber höchst auffällig, ist die hohe Prävalenz von Schilddrüsenerkrankungen, insbesondere der Hypothyreose, bei sekundären LÖ.

Abstract

Aim To analyse the prevalence of comorbidities in lymphoedema patients.

Methods Retrospective analysis of 457 consecutive cases of the lymphoedema clinic at a university hospital in Berlin, Germany.

Results N = 391 lymphoedema cases could be analysed. N = 51 primary lymphoedema (pL) and n = 340 secondary lymphoedema (sL) cases. The overall female to male ratio was 9:1. Patients with sL showed an average body mass index of 33,8 and a proportion of 64 % obese (21 % had a BMI over 40). The prevalence of recurring erysipelas was comparable in pL (7,8 %) and sL (7,9 %). In the group of sL there could be observed a 30 % prevalence of thyroid diseases, mostly hypothyroidism.

Discussion Age and sex can partly explain the observed prevalences. Obesity, a well-known risk factor for the development of Lymphoedema, shows noticeable prevalence rates in sL. Prevalence of recurring erysipelas is comparable in both groups and does not seem to be dependent of the lymphoedema cause. The high prevalence of hypothyroidism in sL should be subject to further prospective studies.

Schlüsselwörter

Lymphödem - primäres Lymphödem - sekundäres Lymphödem - Komorbidität - Risikofaktoren

Key words

lymphoedema - primary lymphoedema - secondary lymphoedema - comorbidity - risk factors


Publication History

Received: 18 March 2019

Accepted: 27 March 2019

Article published online:
31 January 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Valderas J, Starfield B, Sibbald B. et al Defining Comorbidity: Implications for Understanding Health and Health Services. Annals of Family Medicine 2009; 4: 357-363
    Google Scholar
  • 2 ISL. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46: 1-11
    PubMedGoogle Scholar
  • 3 AWMF. S2k Leitlinie Diagnostik und Therapie der Lymphödeme. AWMF Reg.-Nr 2017; 058–001
    Google Scholar
  • 4 Dougados M, Soubrier M, Antunez A. et al Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2014; 73: 62-68
    PubMedGoogle Scholar
  • 5 Ribeiro Pereira ACP, Koifman RJ, Bergmann A. Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up. Breast 2017; 36: 67-73
    CrossrefPubMedGoogle Scholar
  • 6 Kim M, Shin KH, Jung SY. et al Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer. Cancer Res Treat 2016; 48: 1330-1337
    CrossrefPubMedGoogle Scholar
  • 7 Dean LT, Kumar A, Kim T. et al Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema. Journal of Obesity. vol. 2016, Article ID 8241710, 9 pages, 2016
    PubMedGoogle Scholar
  • 8 Das N, Baumgartner RN, Riley EC. et al Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors. J Cancer Surviv 2015; 9: 422-430
    CrossrefPubMedGoogle Scholar
  • 9 Rebegea L, Firescu D, Dumitru M. et al The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer. Chirurgia (Bucur) 2015; 110: 33-37
    Google Scholar
  • 10 Jung SY, Shin KH, Kim M. et al Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 2014; 148: 91-98
    CrossrefPubMedGoogle Scholar
  • 11 Zhu YQ, Xie YH, Liu FH. et al Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev 2014; 15: 6535-6541
    CrossrefPubMedGoogle Scholar
  • 12 Togawa K, Ma H, Sullivan-Halley J. et al Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study. Breast Cancer Res 2014; 16: 414
    CrossrefPubMedGoogle Scholar
  • 13 Monleon S, Murta-Nascimento C, Bascuas I. et al Lymphedema Predictor Factors after Breast Cancer Surgery: A Survival Analysis. Lymphat Res Biol 2015; 13: 268-274
    CrossrefPubMedGoogle Scholar
  • 14 Boughey JC, Hoskin TL, Cheville AL. et al Risk factors associated with breast lymphedema. Ann Surg Oncol 2014; 21: 1202-1208
    CrossrefPubMedGoogle Scholar
  • 15 Ugur S, Arıcı C, Yaprak M. et al Risk factors of breast cancer-related lymphedema. Lymphat Res Biol 2013; 11: 72-75
    CrossrefPubMedGoogle Scholar
  • 16 Kim M, Kim SW, Lee SU. et al A model to estimate the risk of breast cancer-related lymphedema: combinations of treatment-related factors of the number of dissected axillary nodes, adjuvant chemotherapy, and radiation therapy. Int J Radiat Oncol Biol Phys 2013; 86: 498-503
    CrossrefPubMedGoogle Scholar
  • 17 Dominick SA, Madlensky L, Natarajan L. et al Risk factors associated with breast cancer-related lymphedema in the WHEL Study. J Cancer Surviv 2013; 7: 115-123
    CrossrefPubMedGoogle Scholar
  • 18 Bar Ad V, Dutta P, Solin L. et al Time-course of arm lymphedema and potential risk factors for progression of lymphedema after breast conservation treatment for early stage breast cancer. Breast J 2012; 18: 219-225
    CrossrefPubMedGoogle Scholar
  • 19 Shah C, Wilkinson JB, Baschnagel A. et al Factors associated with the development of breast cancer-related lymphedema after whole-breast irradiation. Int J Radiat Oncol Biol Phys 2012; 83: 1095-1100
    CrossrefPubMedGoogle Scholar
  • 20 Ahmed RL, Schmitz KH, Prizment AE. et al Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study. Breast Cancer Res Treat 2011; 130: 981-991
    CrossrefPubMedGoogle Scholar
  • 21 Goldberg JI, Riedel ER, Morrow M. et al Morbidity of sentinel node biopsy: relationship between number of excised lymph nodes and patient perceptions of lymphedema. Ann Surg Oncol 2011; 18: 2866-2872
    CrossrefPubMedGoogle Scholar
  • 22 Hayes SC, Rye S, Battistutta D. et al Prevalence of upper-body symptoms following breast cancer and its relationship with upperbody function and lymphedema. Lymphology 2010; 43: 178-187
    PubMedGoogle Scholar
  • 23 Norman SA, Localio AR, Kallan MJ. et al Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev 2010; 19: 2734-2746
    CrossrefPubMedGoogle Scholar
  • 24 Goldberg JI, Wiechmann LI, Riedel ER. et al Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol 2010; 17: 3278-3286
    CrossrefPubMedGoogle Scholar
  • 25 Clough-Gorr KM, Ganz PA, Silliman RA. Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up. Breast J 2010; 16: 147-155
    CrossrefPubMedGoogle Scholar
  • 26 Tsai RJ, Dennis LK, Lynch CF. et al The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 2009; 16: 1959-1972
    CrossrefPubMedGoogle Scholar
  • 27 Yen TW, Fan X, Sparapani R. et al A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol 2009; 16: 979-988
    CrossrefPubMedGoogle Scholar
  • 28 Meeske KA, Sullivan-Halley J, Smith AW. et al Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat 2009; 113: 383-391
    CrossrefPubMedGoogle Scholar
  • 29 Kuroda K, Yamamoto Y, Yanagisawa M. et al Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Womens Health 2017; 17: 50
    CrossrefPubMedGoogle Scholar
  • 30 Hayes SC, Janda M, Ward LC. et al Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecol Oncol 2017; 146: 623-629
    CrossrefPubMedGoogle Scholar
  • 31 Lindqvist E, Wedin M, Fredrikson M. et al Lymphedema after treatment for endometrial cancer – A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211: 112-121
    CrossrefPubMedGoogle Scholar
  • 32 Kim M, Suh DH, Yang EJ. et al Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers. Gynecol Oncol 2017; 144: 153-158
    CrossrefPubMedGoogle Scholar
  • 33 Ki EY, Park JS, Lee KH. et al Incidence and Risk Factors of Lower Extremity Lymphedema After Gynecologic Surgery in Ovarian Cancer. Int J Gynecol Cancer 2016; 26: 1327-1332
    CrossrefPubMedGoogle Scholar
  • 34 Hareyama H, Hada K, Goto K. et al Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer 2015; 25: 751-757
    CrossrefPubMedGoogle Scholar
  • 35 Beesley VL, Rowlands IJ, Hayes SC. et al Australian National Endometrial Cancer Study Group. Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer. Gynecol Oncol 2015; 136: 87-93
    CrossrefPubMedGoogle Scholar
  • 36 Yost KJ, Cheville AL, Al-Hilli MM. et al Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and quality of life. Obstet Gynecol 2014; 124 (02) 307-315
    CrossrefPubMedGoogle Scholar
  • 37 Deura I, Shimada M, Hirashita K. et al Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy. Int J Clin Oncol 2015; 20: 556-560
    CrossrefPubMedGoogle Scholar
  • 38 Graf N, Rufibach K, Schmidt AM. et al Frequency and risk factors of lower limb lymphedema following lymphadenectomy in patients with gynecological malignancies. Eur J Gynaecol Oncol 2013; 34: 23-27
    PubMedGoogle Scholar
  • 39 Akita S, Mitsukawa N, Rikihisa N. et al Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer. Plast Reconstr Surg 2013; 131: 283-290
    CrossrefPubMedGoogle Scholar
  • 40 Kim JH, Choi JH, Ki EY. et al Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer 2012; 22: 686-691
    CrossrefPubMedGoogle Scholar
  • 41 Ohba Y, Todo Y, Kobayashi N. et al Risk factors for lower-limb lymphedema after surgery for cervical cancer. Int J Clin Oncol 2011; 16: 238-243
    CrossrefPubMedGoogle Scholar
  • 42 Todo Y, Yamamoto R, Minobe S. et al Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol 2010; 119: 60-64
    CrossrefPubMedGoogle Scholar
  • 43 Tada H, Teramukai S, Fukushima M. et al Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer 2009; 9: 47
    CrossrefPubMedGoogle Scholar
  • 44 Friedman JF, Sunkara B, Jehnsen JS. et al Risk factors associated with lymphedema after lymph node dissection in melanoma patients. Am J Surg 2015; 210: 1178-1184 , discussion 1184
    CrossrefPubMedGoogle Scholar
  • 45 Deng J, Fu MR, Armer JM. et al Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema. Rehabil Nurs 2015; 40: 310-319
    CrossrefPubMedGoogle Scholar
  • 46 Teerachaisakul M, Ekataksin W, Durongwatana S. et al Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology 2013; 46: 150-156
    PubMedGoogle Scholar
  • 47 Okajima S, Hirota A, Kimura E. et al Health-related quality of life and associated factors in patients with primary lymphedema. Jpn J Nurs Sci 2013; 10: 202-211
    CrossrefPubMedGoogle Scholar
  • 48 Hoshika Y, Hamamoto T, Sato K. et al Prevalence and clinical features of lymphedema in patients with lymphangioleiomyomatosis. Respir Med 2013; 107: 1253-1259
    CrossrefPubMedGoogle Scholar
  • 49 Deng J, Ridner SH, Dietrich MS. et al Factors associated with external and internal lymphedema in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 2012; 84: e319-e328
    CrossrefPubMedGoogle Scholar
  • 50 von Elm E, Altman DG, Egger M. et al STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4: e296
    CrossrefPubMedGoogle Scholar
  • 51 Mensink G, Schienkiewitz A, Haftenberger M. et al Übergewicht und Adipositas in Deutschland – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 786-794
    CrossrefPubMedGoogle Scholar
  • 52 Fuchs J, Rabenberg M, Scheidt-Nave C. Prävalenz ausgewählter muskuloskelettaler Erkrankungen – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 678-686
    CrossrefPubMedGoogle Scholar
  • 53 Hollowell JG, Staehling NW, Flanders WD. et al Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-499
    CrossrefPubMedGoogle Scholar
  • 54 Völzke H, Lüdemann J, Robinson DM. et al The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810
    CrossrefPubMedGoogle Scholar
  • 55 Zink A, Albrecht K. Wie häufig sind muskuloskelettale Erkrankungen in Deutschland?. Z Rheumatol 2016; 75: 346-353
    CrossrefPubMedGoogle Scholar
  • 56 Simard JF, Costenbader KH. Epidemiology and classification of systemic lupus erythematodes. In Hochberg MC, Silman AJ. et al., (Hrsg.). Rheumatology. . (6th edition) 124. Philadelphia: Elsevier; 2015: 1021-1025
    CrossrefGoogle Scholar
  • 57 Brückle W. Fibromyalgiesyndrom – die neue Leitlinie. In: Z Rheumatol. 68. 2009: 451-458
    Google Scholar
  • 58 Hanewinckel R, Drenthen J, van Oijen M. et al Prevalence of polyneuropathy in the general middle-aged and elderly population. Neurology 2016; 87: 1892-1898
    CrossrefPubMedGoogle Scholar
  • 59 Janhsen K, Strube H, Starker A. Gesundheitsberichterstattung des Bundes: Hypertonie. 43. Berlin: Robert Koch-Institut; 2008: 10
    Google Scholar
  • 60 Park SI, Yang EJ, Kim DK. et al Prevalence and Epidemiological Factors Involved in Cellulitis in Korean Patients With Lymphedema. Ann Rehabil Med 2016; 40: 326-333
    CrossrefPubMedGoogle Scholar
  • 61 Iurkevich NP, Savchenko TV. Lymphedema and hypothyreoidism. Klin Med (Mosk.) 1994; 72: 33-36
    PubMedGoogle Scholar
  • 62 Jones AL, Webb DJ. Selective IgA deficiency, hypothyroidism and congenital lymphoedema. Scott Med J 1996; 41: 22-23
    CrossrefPubMedGoogle Scholar
  • 63 Al-Khader AA, Aber GM. The relationship between the ‘idiopathic oedema syndrome’ and subclinical hypothyroidism. Clin Endocrinol 1979; 10: 271-279
    CrossrefPubMedGoogle Scholar
  • 64 Wu D, Gibbs J, Corral D. et al Massive localized lymphedema: additional locations and association with hypothyroidism. Hum Pathol 2000; 31: 1162-1168
    CrossrefPubMedGoogle Scholar
  • 65 Fu M, Ridner S, Hu S. et al Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psycho-Oncology 2013; 22: 1466-1484
    CrossrefPubMedGoogle Scholar
  • 66 Rabe E, Bauersachs RM, Pannier F. et al Gesundheitsberichterstattung des Bundes: Venenerkrankungen der Beine. 44. Berlin: Robert Koch-Institut; 2009
    Google Scholar
  • 67 Göpner-Reinecke C. Wissenschaftliches Institut der AOK. Frauen häufiger in physiotherapeutischer Behandlung als Männer. Pressemitteilung. 2017 zugegriffen am 28.09.2018, verfügbar unter https://aok-bv.de/presse/pressemitteilungen/2017/index_19784.html
    PubMedGoogle Scholar
  • 68 Ritter S, Storrer D, Weigl M. et al Status Quo der Wissenschaft und Forschung in der Physikalischen Medizin und Rehabilitation in Deutschland. Phys Med Rehab Kuror 2018; 28: 219-223 .doi:10.1055/a-0596-7918
    Article in Thieme ConnectGoogle Scholar
  • 69 Liebl M, Schuester L, Reißhauer A. Prävalenz von Komorbiditäten bei Lymphödemerkrankungen. Phys Med Rehab Kuror 2018; 28: 246 . doi:10.1055/s-0038-1668280
    Google Scholar