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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2019; 29(05): 282-289
DOI: 10.1055/a-0885-1868
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Prävalenz von Komorbiditäten bei Lymphödemerkrankungen

Prevalence of Comorbidities in Lymphedema
Anett Reißhauer
1   Physikalische Medizin und Rehabilitation, Charité Universitätsmedizin Berlin, Berlin
,
Leon Schuester
1   Physikalische Medizin und Rehabilitation, Charité Universitätsmedizin Berlin, Berlin
,
Annelies Kling
1   Physikalische Medizin und Rehabilitation, Charité Universitätsmedizin Berlin, Berlin
,
Max Emanuel Liebl
1   Physikalische Medizin und Rehabilitation, Charité Universitätsmedizin Berlin, Berlin
› Institutsangaben
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Publikationsverlauf

eingereicht18. März 2019

akzeptiert 27. März 2019

Publikationsdatum:
19. Juli 2019 (online)

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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 Lymphödemerkrankungen der Hochschulambulanz einer Universitätsklinik hinsichtlich der Prävalenz von Komorbiditäten.

Ergebnisse n=391 Fälle kamen zur Auswertung, getrennt nach Ödemgenese, 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-PatientInnen einen BMI vergleichbar der altersentsprechenden Referenzgruppe der Allgemeinbevölkerung aufweisen, zeigen PatientInnen mit sL einen durchschnittlichen BMI von 33,8 und einen Anteil von 64% adipöser Patientinnen (21% mit BMI über 40). Die Prävalenz rezidivierender Erysipele ist mit 7,8 bzw. 7,9% zwischen pL und sL vergleichbar häufig. Weitere Prävalenzen wie Diagnosen aus dem muskuloskeletalen Bereich (ICD-Kapitel XIII/„M“) zeigten sich in der Stichprobe in altersgerechter Verteilung. Eine besonders hohe Prävalenz zeigen in der Gruppe der sL Schilddrüsenerkrankungen (30%), dabei überwiegend die Schilddrüsenunterfunktion.

Diskussion Nur z. T. kann 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
 

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