托里消毒散内服联合四黄膏外敷治疗非哺乳期乳腺炎脓肿期的疗效及其对NLRP3炎症小体的影响  

The Efficacy of Oral Toli Xiaodu Powder Combined with Topical Sihuang Ointment in the Treatment of Non-lactational Mastitis in the Abscess Stage and Its Impact on the NLRP3 Inflammasome

作　　者：麻丽珍[1] 穆文宏 杨满英 唐芳雅 MA Lizhen;MU Wenhong;YANG Manying;TANG Fangya(Department of Galactophore,Huadu District Maternity and Child Care Hospital of Guangzhou(Hu Zhong Hospital),Guangzhou 510800,China)

机构地区：[1]广州市花都区妇幼保健院(胡忠医院)乳腺科,广州510800

出　　处：《微循环学杂志》2025年第1期32-38,共7页Chinese Journal of Microcirculation

摘　　要：目的:探讨托里消毒散内服联合四黄膏外敷治疗非哺乳期乳腺炎(NPM)脓肿期的疗效及其对患者创面肉芽组织核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体的影响。方法:选取本院2021-02-2023-12收治的120例NPM患者,按随机数字表法分为试验组(60例)和对照组(60例)。两组患者均进行手术切开排脓,并予口服甲泼尼龙治疗,在此基础上,试验组额外采用托里消毒散内服联合四黄膏外敷治疗,连续3个月。分别于治疗前及治疗后1、2、3月,测定乳腺创面局部症状评分、创面肉芽组织NLRP3炎症小体及其下游致炎效应因子水平;治疗期间进行安全性评价,并于疗程结束后评价临床疗效,并开展进行6个月的有效随访记录患者复发情况。结果:组内比较:与治疗前比较,两组患者各时间点渗出液性质、红肿范围、肉芽生长情况、疼痛程度、白细胞介素(IL)-1β、IL-18以及创面肉芽组织中NLRP3、ASC、Caspase-1 mRNA均显著降低,两两比较差异均有统计学意义(P<0.05);组间比较:试验组治疗后1月、2月、3月渗出液性质、红肿范围、肉芽生长情况、疼痛程度、IL-1β、IL-18以及NLRP3、ASC、Caspase-1 mRNA均低于对照组(P<0.05)。试验组的总有效率91.67%(55/60)明显高于对照组的78.33%(47/60)。而试验组复发率3.33%(2/60)明显低于对照组的15.00%(9/60),差异均有统计学意义(P<0.05),同时两组不良反应发生率差别无统计学意义(P>0.05)。结论:托里消毒散内服联合四黄膏外敷在治疗NPM脓肿期患者中有较好疗效,可抑制NLRP3炎症小体的激活,改善炎症损伤,促进创面愈合,且安全性较好。Objective:To investigate the efficacy of oral Toli Xiaodu Powder combined with topical Sihuang Ointment in treating non-lactational mastitis(NPM)during the abscess stage and its impact on the nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome in wound granulation tissue.Method:A total of 120 NPM patients from February 2021 to December 2023 were selected and randomly divided into a trial group(n=60)and a control group(n=60)using a random number table.All patients underwent surgical incision and drainage followed by oral methylprednisolone treatment.Additionally,the trial group received oral Toli Xiaodu Powder combined with topical Sihuang Ointment for three months.Local wound symptom scores,levels of NLRP3 inflammasome,and downstream pro-inflammatory effectors in granulation tissue were measured before treatment and at 1,2,and 3 months after treatment.Safety evaluations were conducted during the treatment period,and clinical efficacy was assessed at the end of the treatment course.A six-month follow-up was conducted to record recur rence rates.Results:Intra-group comparisons:compared with pre-treatment,both groups showed significant reductions in exudate characteristics,redness and swelling range,granulation growth,pain severity,and the levels of IL-1β,IL-18,as well as NLRP3,ASC,and Caspase-1 mRNA at each time point after treatment,with statistically significant differences in pairwise comparisons(P<0.05).Between-group comparisons:at 1,2,and 3 months post-treatment,the trial group demonstrated significantly lower exudate characteristics,redness and swelling range,granulation growth,pain severity,and levels of IL-1β,IL-18,NLRP3,ASC,and Caspase-1 mRNA were decreased compared to the control group(P<0.05).The total effective rate of the trial group was 91.67%(55/60),which was significantly higher than that of the control group at 78.33%(47/60)(P<0.05).Additionally,the recurrence rate in the trial group was 3.33%(2/60),markedly lower than that in the control group at 15.00%(9/60),wit

关 键 词：托里消毒散 四黄膏外敷 非哺乳期乳腺炎脓肿期 NLRP3炎症小体 中医药疗法 

分 类 号：R269[医药卫生—中西医结合] R655.8[医药卫生—中医外科学]