Auf der Suche nach der Evidenz: Eine systematische Übersichtsarbeit zur Pathologie des Lipödems

Zusammenfassung

Hintergrund Das Lipödem bezeichnet eine symmetrisch lokalisierte, schmerzhafte Vermehrung des subkutanen Fettgewebes an den Extremitäten mit deutlicher Disproportion zum Stamm, von der fast ausschließliche Frauen betroffen sind. Obwohl die Erstbeschreibung über 80 Jahre zurückliegt, sind die Ätiologie und Pathogenese der Erkrankung bislang weitestgehend ungeklärt und zurzeit Inhalt intensiver Forschungsarbeit.

Methoden Zur Zusammenfassung der aktuellen evidenz-basierten Literatur zur Pathologie, Pathohistologie und Pathogenese des Lipödems erfolgte eine PRISMA-basierte systematische Literaturrecherche innerhalb der National Library of Medicine und Cochrane-Datenbank.

Ergebnisse Insgesamt konnten 53 Studien identifiziert und in diese Übersicht inkludiert werden. Die Ergebnisse wurden in Kategorien klassifiziert und zusammengefasst.

Schlussfolgerung Trotz einer deutlichen Zunahme der Forschungsaktivität und der Veröffentlichung umfangreicher Studien mit histologischem und molekulargenetischem Schwerpunkt in den letzten Jahren, bleibt die grundlegende Ätiologie und Pathologie der Erkrankung Lipödem weitestgehend uneindeutig. Die aktuelle Datenlage weist studienübergreifend Diskrepanzen auf, insbesondere die „ödematöse“ Komponente des Lipödems ist umstritten. Die häufig-vorliegenden Ko-Morbiditäten „Lymphödem“ und „Übergewicht“, vornehmlich in fortgeschrittenen Stadien, erschweren die differentialdiagnostische Abgrenzung und klare Definition von Studienkohorten in der wissenschaftlichen Forschung.

Abstract

Background Lipoedema is a symmetrically localised, painful hypertrophy of subcutaneous adipose tissue in the extremities with marked disproportion to the trunk, and almost exclusively affects females. Despite being first described over 80 years ago, the aetiology and pathogenesis of the disease are largely unknown and are currently the subject of intensive research efforts.

Methods To summarise the current evidence-based literature on the cellular pathologies and aetiology of lipoedema, a PRISMA-based systematic review was conducted within the National Library of Medicine and Cochrane databases.

Results A total of 53 studies were identified and included in this review. The results were classified and summarised into categories.

Conclusion Although there has been a significant increase in research activity and recent publication of extensive studies with a histological and molecular genetic focus, the fundamental aetiology and pathology of lipoedema remains largely unclear. The current data shows discrepancies across studies, particularly with regard to the “oedematous” component of lipoedema. The frequently present comorbidities “lymphoedema” and “obesity”, primarily in advanced stages of lipoedema, complicate the diagnostic differentiation and clear definition of study cohorts in scientific research.

Schlüsselwörter

Lipödem - Fettverteilungsstörung - Fettgewebe - ASCs - Liposuktion - PRISMA

Key words

Lipedema - Adipose tissue-derived Stem Cells - ASC - Liposuction - Fat tissue - PRISMA

^‡ Geteilte Erstautorenschaft

^* Geteilte Letztautorenschaft

Publication History

Received: 06 July 2023

Accepted: 04 September 2023

Article published online:
20 November 2023

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