中医药内外合治对肉芽肿性乳腺炎的影响及作用机制研究  

Effect and Mechanism of Internal and External Treatment by Traditional Chinese Medicine on Granulomatous Mastitis

作　　者：董兰蔚 叶媚娜[1] 殷玉莲[1] 仲芫沅 王冰[1] 陈红风[1] DONG Lanwei;YE Meina;YIN Yulian;ZHONG Yuanyuan;WANG Bing;CHEN Hongfeng(Traditional Chinese Medicine Department of Breast Disease,Longhua Hospital,Shanghai University of Trditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院中医乳腺科,上海200032

出　　处：《山东中医杂志》2021年第12期1326-1331,1336,共7页Shandong Journal of Traditional Chinese Medicine

基　　金：陈红风上海市名老中医学术经验研究工作室(编号:SHGZS-2017018);上海中医乳腺病专科联盟(编号:LH02.68.014);上海中医药大学附属龙华医院育苗计划科研项目(编号:LYTD-74)。

摘　　要：目的:观察四联外治法联合中药内服治疗肉芽肿性乳腺炎(GM)的临床疗效,探讨其作用机制。方法:纳入60例GM患者,予“切扩-拖线-熏洗-垫棉”四联外治法联合中药内服进行综合治疗,检测治疗前后血清白细胞介素(IL)-2、可溶性白细胞介素-2受体(sIL-2R)、IL-4、IL-6、γ-干扰素(IFN-γ)、转化生长因子β(TGF-β)水平,评价临床疗效,并进行随访,评估预后。结果:60例患者治愈57例,好转1例,未愈2例,有效率96.67%。未愈的2例患者在出院后3个月内出现同侧乳房复发炎性肿块,复发率为3.33%。术后1周时,血清IL-6、TGF-β水平较治疗前上升(P<0.05),sIL-2R水平较治疗前下降(P<0.05)。术后3周时的血清IL-6、sIL-2R水平较治疗前降低(P<0.05),而IL-2、IL-4、IFN-γ、TGF-β水平较治疗前无明显变化(P>0.05);sIL-2R/IL-2比值较治疗前减小(P<0.05),TGF-β/IL-6、IL-2/IL-6比值较治疗前增大(P<0.05),提示Treg/Th17、Th1/Th2比值增大。结论:中医药内外合治在GM的临床治疗中有良好疗效,其机制可能与调节免疫细胞的功能及细胞间平衡有关。Objective:To observe the clinical efficacy of quadruple external treatment combined with oral administration of Chinese medicinal on granulomatous mastitis(GM),and to investigate the underlying mechanism.Methods:Sixty patients with GM were included and treated with quadruple external treatments,including incision and expansion-thread dragging-fumigation and washing-cotton pad,combined with oral administration of Chinese medicinal.Serum levels of interleukin(IL)-2,soluble IL-2 receptor(sIL-2R),IL-4,IL-6,interferon(IFN)-γ,and transforming growth factor(TGF)-βwere tested,the clinical efficacy was evaluated and the follow-up was conducted to evaluate the prognosis.Results:In the 60 patients with GM,57 patients were cured,1 patient was with improvement,and 2 patients were without effect,with an effective rate of 96.67%.Two patients without effect developed recurrent inflammatory lumps in the ipsilateral breast within 3 months after discharge,and the recurrence rate was 3.33%.One week after the treatment,the serum levels of IL-6 and TGF-βwere higher than those before the treatment(P<0.05),the serum level of sIL-2R was lower than that before the treatment(P<0.05).Three weeks after the treatment,the serum levels of IL-6 and sIL-2R were lower than those before the treatment(P<0.05);there is no significant difference in serum levels of IL-2,IL-4,IFN-γand TGF-βbetween before treatment and after the treatment(P>0.05);the sIL-2R/IL-2 ratio was significantly reduced(P<0.05),and the TGF-β/IL-6 and IL-2/IL-6 ratios were significantly increased compared with those before the treatment(P<0.05),suggesting that Treg/Th17 and Th1/Th2 ratios were increased.Conclusion:The internal and external TCM treatment for GM achieves good clinical efficacy,and the mechanisms may be regulating the balance and function of immune cells.

关 键 词：肉芽肿性乳腺炎 中药熏洗 拖线法 柴胡清肝汤 托里消毒散 免疫机制 T细胞亚群 

分 类 号：R271.44[医药卫生—中医妇科学]