局部应用皮质类固醇治疗特发性肉芽肿性乳腺炎疗效与安全性的Meta分析  

Efficacy and safety of local corticosteroids in the treatment of idiopathic granulomatous mastitis:A systematic review and meta-analysis

作　　者：李萌 李雄雄 徐婷 尚进 Li Meng;Li Xiongxiong;Xu Ting;Shang Jin(Department of Breast Surgery,Xi’an People’s Hospital(Xi’an Fourth Hospital),Xi’an 710004,China)

机构地区：[1]西安市人民医院(西安市第四医院)乳腺外科,710004

出　　处：《中华普通外科学文献(电子版)》2025年第2期135-141,共7页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的评估局部应用皮质类固醇治疗特发性肉芽肿性乳腺炎(IGM)的疗效与安全性。方法系统检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、CBM、万方医学网及维普数据库,检索时限均从建库至2024年4月1日,对纳入的相关随机对照试验研究进行质量评价,并进行Meta分析和亚组分析,以获得感兴趣结果的合并效应量。结果共纳入8项试验,包括596例患者。试验组为局部类固醇给药,包括病灶内注射和外用类固醇软膏,对照组主要给予系统治疗(口服类固醇)和穿刺抽脓/引流治疗。Meta分析结果显示,局部应用皮质类固醇(包括病灶内注射和外用药膏),相比口服类固醇或穿刺抽脓/引流治疗有效率显著提升(RR=1.34,95%CI:1.10~1.63,P=0.004),不良反应发生率较低(RR=0.42,95%CI:0.22~0.80,P=0.009),治疗起效时间(MD=-3.51,95%CI:-4.62~-2.40,P<0.00001)及住院时间(MD=-6.69,95%CI:-7.34~-6.04,P<0.00001)存在优势,复发率无明显差异(RR=0.85,95%CI:0.36~2.01,P=0.71)。结论局部应用皮质类固醇可提高IGM治疗有效率,减少不良反应的发生,起效时间较短,可作为一种有效的治疗方法,用于优化IGM治疗的效果,提高患者的治疗体验和安全性。Objective To evaluate the efficacy and safety of the local application of corticosteroids in the treatment of idiopathic granulomatous mastitis(IGM).Methods A systematic search was conducted in databases including PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),CBM,Wanfang,and VIP up to April 2024 to identify relevant randomized controlled trials.The quality of the included studies was assessed,and a meta-analysis and subgroup analysis were performed to obtain the pooled effect size for the outcomes of interest.Results A total of 8 trials involving 596 patients were included.Local corticosteroid administration in the trial group included intralesional injection and topical corticosteroid ointments,while the control group mainly received systemic treatment(oral corticosteroids)and aspiration/drainage procedures.The meta-analysis results showed that local application of corticosteroids(including intralesional injection and topical ointments)was significantly improved effectiveness compared to oral corticosteroids or aspiration/drainage therapy(RR=1.34,95%CI:1.10-1.63,P=0.004).The incidence of adverse effects was also lower in the local corticosteroid group compared to the control group(RR=0.42,95%CI:0.22-0.80,P=0.009).Local corticosteroid treatment had advantages in terms of the time to treatment effectiveness(MD=-3.51,95%CI:-4.62--2.40,P<0.00001)and hospital stay(MD=-6.69,95%CI:-7.34--6.04,P<0.00001),with no significant difference in recurrence rates between groups(RR=0.85,95%CI:0.36-2.01,P=0.71).Conclusions Local corticosteroids application can improve the response rate in patients with IGM,reduce the incidence of adverse effects,and result in shorter time to treatment effectiveness.This approach can serve as an effective treatment method to optimize the outcomes of IGM therapy and improve patient treatment experience and safety.

关 键 词：肉芽肿性乳腺炎 皮质类固醇 局部用药 疗效 META分析 

分 类 号：R655.8[医药卫生—外科学]