【摘要】：目的:對比分析棒狀桿菌感染的肉芽腫性小葉性乳腺炎患者與非棒狀桿菌感染患者之間的臨床特征,探尋兩者之間的差異性,提高對此類患者臨床特征的認(rèn)識。方法:采用回顧性臨床資料對比分析方法,將我院2015年1月-2016年9月住院經(jīng)病理診斷為肉芽腫性小葉性乳腺炎(GLM)且行細(xì)菌培養(yǎng)的患者分為兩組,A組:非棒狀桿菌感染的肉芽腫性小葉性乳腺炎患者;B組:棒狀桿菌感染的肉芽腫性小葉性乳腺炎患者。將兩組患者的病例資料建立數(shù)據(jù)庫,運用X2檢驗、秩和檢驗、Fisher確切概率法等統(tǒng)計方法,探討棒狀桿菌感染的GLM患者與非棒狀桿菌感染者之間臨床特征的差異性以及可能影響菌培結(jié)果相關(guān)因素,得出結(jié)論。結(jié)果:1.一般情況棒狀桿菌感染的GLM患者的發(fā)病距末次生產(chǎn)時間平均為4.09±2.50年,與非棒狀桿菌感染者(3.98±4.82年)相比,棒狀桿菌感染者的發(fā)病距末次生產(chǎn)的時間更長,差別有統(tǒng)計學(xué)意義(P0.05)。棒狀桿菌感染的GLM患者的平均發(fā)病年齡、發(fā)病年齡的構(gòu)成比、生育次數(shù)、哺乳時長、發(fā)病距末次哺乳時間、哺乳期間有無乳腺炎、患側(cè)乳房外傷史、口服避孕藥史、抑郁癥病史方面均無明顯差異(P0.05)。2.臨床表現(xiàn)棒狀桿菌感染的GLM患者的腫塊大小平均為7.24±2.89cm,比非棒狀桿菌感染者的腫塊明顯更大(6.42±2.82cm),且差別有統(tǒng)計學(xué)意義(P0.05)。棒狀桿菌感染的GLM患者可出現(xiàn)乳頭短小或凹陷及乳頭溢液,單側(cè)或雙側(cè)乳房均可發(fā)病,皮膚潮紅腫脹,初起腫塊集中于外周象限,疼痛與腫塊并存,在發(fā)病過程中可出現(xiàn)發(fā)熱及四肢紅斑,以上表現(xiàn)與非棒狀桿菌感染者相似(P0.05)。3入院時的臨床分型、分期及辨證棒狀桿菌感染的GLM患者入院時的臨床分型分期中主要為膿腫型、急性期,入院時初期臨床辨證多見熱毒熾盛。與非棒狀桿菌感染者相比,差異無統(tǒng)計學(xué)意義(P0.05)。4.其他指標(biāo)棒狀桿菌感染的GLM患者再次入院率高于非棒狀桿菌感染者,差異有統(tǒng)計學(xué)意義(P0.05)。棒狀桿菌感染的GLM患者伴高泌乳素血癥的情況,與非棒狀桿菌感染者相比,差異無統(tǒng)計學(xué)意義(P0.05)。棒狀桿菌感染的GLM患者取材距離發(fā)病的時長平均為2.02±2.12月,與非棒狀桿菌感染者相比,合并棒狀桿菌感染者更短,差別有統(tǒng)計學(xué)意義(P0.01)棒狀桿菌感染的GLM患者取材時的分型分期多為膿腫型、急性期,以膿液為主,與非棒狀桿菌感染者相比無差異。結(jié)論:棒狀桿菌感染的GLM患者發(fā)病距離末次生產(chǎn)的時間更長,腫塊相對較大,再次入院率更高。棒狀桿菌感染的GLM患者取材距離發(fā)病的時長更短,提示我們發(fā)病早期可能更有利于棒狀桿菌的檢出,距離末次生產(chǎn)時間越久,乳腺導(dǎo)管內(nèi)的生理變化可能更有利于細(xì)菌的生長。但兩組間的臨床特征大部分未見明顯差異,考慮棒狀桿菌感染的GLM不一定是一種特殊的乳腺炎。
[Abstract]:Objective: to compare and analyze the clinical characteristics between patients with granulomatous lobular mastitis infected with Corynebacterium and those with non-Corynebacterium infection, and to explore the difference between them, so as to improve the understanding of the clinical characteristics of these patients. Methods: the patients with granulomatous lobular mastitis (GLM) diagnosed pathologically in our hospital from January 2015 to September 2016 were divided into two groups. Group A: patients with granulomatous lobular mastitis without Corynebacterium infection; Group B: patients with granulomatous lobular mastitis infected with Corynebacterium. The case data of the two groups of patients were established database, and the statistical methods such as X2 test, rank sum test, Fisher exact probability method and so on were used. To investigate the difference of clinical characteristics between GLM patients infected with Corynebacterium and non-Corynebacterium infection and the related factors that may affect the results of bacterial culture, and draw a conclusion. Result: 1. In general, the average time between the onset and the last delivery of GLM patients with Corynebacterium infection was 4.09 鹵2.5 years. Compared with non-Corynebacterium infection (3.98 鹵4.82 years), the onset time of Corynebacterium infection was longer than that of non-Corynebacterium infection (3.98 鹵4.82 years). The difference was statistically significant (P 0.05). The average age of onset, the constituent ratio of onset age, the number of births, the duration of lactation, the time between the onset and the last lactation, the history of mastitis, the history of breast trauma on the affected side and the history of oral contraceptives during lactation. There was no significant difference in the history of depression (P 0.05). 2. The average mass size of GLM patients with Corynebacterium infection was 7.24 鹵2.89 cm, which was significantly larger than that of non-Corynebacterium infection patients (6.42 鹵2.82 cm),) (P 0.05). Patients with GLM infected with Corynebacterium can have short nipple or depression and nipple discharge, unilateral or bilateral breasts can occur, skin flushing and swelling, the initial mass is concentrated in the peripheral quadrant, pain and mass coexist. Fever and erythema of extremities could occur in the course of onset, and the above manifestations were similar to those of non-Corynebacterium infection (P 0.05). 3 Clinical classification at admission. The clinical classification and staging of GLM patients with Corynebacterium tumefaciens infection on admission were mainly abscess type, acute stage, and heat toxin was more common in the early stage of admission. Compared with non-Corynebacterium infection, there was no significant difference (P 0.05). 4. The re-admission rate of GLM patients with Corynebacterium infection was significantly higher than that of non-Corynebacterium infection patients (P 0.05). There was no significant difference in hyperprolactin between GLM patients infected with Corynebacterium and non-Corynebacterium infection (P 0.05). The average time between GLM patients infected with Corynebacterium and Corynebacterium infection was 2.02 鹵2.2 months, which was shorter than that of non-Corynebacterium infection patients. The difference was statistically significant (P 0.01). The classification stage of GLM patients with Corynebacterium infection was mostly abscess type, the acute stage was mainly pus, and there was no difference between Corynebacterium infection and non-Corynebacterium infection. Conclusion: the onset time of GLM patients with Corynebacterium infection is longer than that of the last delivery, the mass is relatively large, and the rate of re-admission to hospital is higher. The longer the GLM patients infected with Corynebacterium, the shorter the time of onset, suggesting that the early stage of the disease may be more conducive to the detection of Corynebacterium. The longer the last production time, the physiological changes in the mammary duct may be more conducive to the growth of bacteria. However, there was no significant difference in clinical features between the two groups. GLM infected with Corynebacterium was not necessarily a special mastitis.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655.8

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