肉芽肿性乳腺炎脓液棒状杆菌的检测及其临床意义的初步探讨
发布时间：2018-08-31 10:21
【摘要】：研究背景肉芽肿性乳腺炎(GM,Granulomatous mastitis)是一种少见的乳腺良性肉芽肿性病变,常发生于经产育龄期妇女。临床上以突发乳腺肿块、脓肿形成、继发窦道和溃疡等为特征的一类非哺乳期乳腺难治性炎症,常反复发作或经久不愈[1.2]。近年来,GM病因不明但发病率逐渐增高,同时也越来越多的研究表明棒状杆菌感染可能与GM的发病机理密切相关[3.4]。我院一项最新研究[5]应用宏基因组学方法对脓肿型GM患者的脓液进行细菌学的系统研究,证明棒状杆菌是GM患者脓液中的优势感染细菌,进一步证实了棒状杆菌在GM发病机制中起重要的促进作用。目前,国内外GM一线治疗方案推荐应用类固醇激素序贯手术治疗[6.8]。但对于合并棒状杆菌感染的GM患者,单纯依靠类固醇激素药物治疗并不能使所有患者获益。临床上普通血平板对GM患者的脓液进行细菌培养率低,难以指导临床进一步用药。文献报道包含吐温80的培养媒介有利于棒状杆菌的培养[9]。另外,细菌PCR检测方法可进一步提高棒状杆菌检测的敏感性。因此,本研究运用包含吐温80的高脂血平板进行棒状杆菌的培养以及PCR方法检测棒状杆菌,并与传统的细菌培养方法进行比较,探讨改进提高棒状杆菌检出率的检测方法。最后,根据GM棒状杆菌的阳性检测结果选择单纯抗生素或抗生素联合类固醇激素治疗,并与临床常规的单纯类固醇激素治疗比较,初步探讨GM脓液棒状杆菌的检测及其对临床用药治疗的指导意义。研究目的1、探讨改进GM脓液棒状杆菌检测方法并提高棒状杆菌的检出率;2、探讨棒状杆菌感染对GM患者临床预后的影响,证明棒状杆菌在GM发病机制中起重要作用;3、探讨抗生素治疗在感染棒状杆菌的GM患者中的临床疗效并指导临床用药方案的制定。研究方法1、通过应用高脂血平板与PCR检测方法提高棒状杆菌的检出率,并通过与普通血平板检出率的对比,检测不同方法之间的优劣;2、根据PCR检测结果制定GM患者不同的治疗方案并进行随访,证明抗生素治疗对感染棒状杆菌的GM患者的重要性。研究结果1、肉芽肿性乳腺炎棒状杆菌的检测方法研究:(1)24例脓液样本分两个重复:行普通血平板培养,阳性率为16.7%;行高脂血平板培养,阳性率为50.0%。棒状杆菌在高脂血平板的细菌培养检出率显著提高了33.3%,两者之间的差异有统计学意义,P=0.014。(2)44例脓液样本分两个重复:行高脂血平板培养,棒状杆菌阳性率36.4%,C.K棒状杆菌阳性率31.2%;行PCR检测,棒状杆菌阳性率50.0%,C.K棒状杆菌阳性率45.5%。两者之间的差异无统计学意义,P=0.197。2、肉芽肿性乳腺炎棒状杆菌检测对临床用药的指导意义:(1)86例脓液标本行PCR检测,棒状杆菌的阳性率为59.3%,阴性率为40.7%;C.K棒状杆菌的阳性率为54.7%,阴性率为45.3%。(2)治疗感染棒状杆菌的GM患者的抗生素方案包括短效左氧氟沙星及阿奇霉素、长效抗分枝杆菌三联药物。(3)随访42例病例,PCR检测棒状杆菌阳性21例,术后复发率23.5%。三组不同治疗方案对感染棒状杆菌的GM患者之间疗效差异有统计学意义,P=0.036。(4)随访42例病例,PCR检测棒状杆菌阴性21例,术后复发率16.7%,两组不同治疗方案对无细菌感染的GM患者之间疗效差异无统计学意义,P=0.719。结论高脂血平板细菌培养及PCR检测方法是可靠、快速的检测GM患者脓液棒状杆菌的方法。GM患者及早发现棒状杆菌的感染对临床指导亲脂抗生素的应用是有意义的。
[Abstract]:Background Granulomatous mastitis (GM) is a rare benign granulomatous lesion of the breast, often occurring in women of childbearing age. Clinically, it is a refractory inflammation of the non-lactating breast characterized by sudden breast mass, abscess formation, secondary sinus tract and ulcer, often recurring or prolonged. In recent years, the etiology of GM is unknown, but the incidence of GM is gradually increasing. At the same time, more and more studies show that Corynebacterium infection may be closely related to the pathogenesis of GM [3.4]. The dominant infectious bacteria further confirm that Corynebacterium plays an important role in the pathogenesis of GM. At present, sequential surgery with steroids is recommended for the first-line treatment of GM at home and abroad. It is reported that the medium containing Tween 80 is beneficial to the culture of Corynebacterium. In addition, bacterial PCR assay can further improve the sensitivity of Corynebacterium detection. Therefore, the use of Tween 80 in this study is high. Corynebacterium Corynebacterium was cultured on a lipid blood plate and detected by PCR. The method was compared with the traditional culture method to improve the detection rate of corynebacterium. Finally, according to the positive test results of GM corynebacterium, antibiotics or antibiotics combined with steroid hormones were selected and compared with the usual clinical practice. Objective 1. To improve the detection method of Corynebacterium pyogenes and to improve the detection rate of Corynebacterium pyogenes; 2. To explore the influence of Corynebacterium infection on the clinical prognosis of patients with GM and to prove that Corynebacterium pyogenes is in GM. 3. To explore the clinical efficacy of antibiotics in patients with Corynebacterium infection and to guide the formulation of clinical drug regimens. Methods 1. To improve the detection rate of Corynebacterium by high-fat blood plate and PCR, and to detect different methods by comparing with the detection rate of common blood plate. Results 1. Detection of Corynebacterium granulomatosus mastitis: 24 cases of pus samples were divided into two repetitions: normal blood plate culture, the positive rate was 16.7. The positive rate of Corynebacterium was increased by 33.3%. The difference was statistically significant (P = 0.014). (2) 44 pus samples were divided into two repetitions: the positive rate of Corynebacterium Corynebacterium was 36.4% and the positive rate of C.K. Corynebacterium was 31.2%. PCR detection was performed. The positive rate of Corynebacterium was 50.0% and that of C.K was 45.5%. There was no significant difference between them. P=0.197.2. The significance of detection of Corynebacterium granulomatosus for clinical medication was as follows: (1) The positive rate of Corynebacterium was 59.3%, the negative rate was 40.7%, and the positive rate of C.K Corynebacterium was 54.7%. Negative rate was 45.3%. (2) Antibiotic regimens for GM patients infected with Corynebacterium included short-acting levofloxacin and azithromycin, long-acting anti-mycobacterium triple drug. (3) Follow-up of 42 cases, 21 cases were positive for Corynebacterium by PCR, and the recurrence rate was 23.5%. The efficacy of the three regimens was poor among GM patients infected with corynebacterium. P = 0.036. (4) Follow-up 42 cases, PCR detection of Corynebacterium negative 21 cases, postoperative recurrence rate of 16.7%. There was no significant difference between the two groups of different treatments for non-bacterial infection of GM patients, P = 0.719. Conclusion High-fat blood plate bacterial culture and PCR detection method is reliable, rapid detection of GM patients pus club shape. The early detection of Corynebacterium infection in GM patients is of great significance for clinical application of lipophilic antibiotics.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.8
本文编号：2214699
[Abstract]:Background Granulomatous mastitis (GM) is a rare benign granulomatous lesion of the breast, often occurring in women of childbearing age. Clinically, it is a refractory inflammation of the non-lactating breast characterized by sudden breast mass, abscess formation, secondary sinus tract and ulcer, often recurring or prolonged. In recent years, the etiology of GM is unknown, but the incidence of GM is gradually increasing. At the same time, more and more studies show that Corynebacterium infection may be closely related to the pathogenesis of GM [3.4]. The dominant infectious bacteria further confirm that Corynebacterium plays an important role in the pathogenesis of GM. At present, sequential surgery with steroids is recommended for the first-line treatment of GM at home and abroad. It is reported that the medium containing Tween 80 is beneficial to the culture of Corynebacterium. In addition, bacterial PCR assay can further improve the sensitivity of Corynebacterium detection. Therefore, the use of Tween 80 in this study is high. Corynebacterium Corynebacterium was cultured on a lipid blood plate and detected by PCR. The method was compared with the traditional culture method to improve the detection rate of corynebacterium. Finally, according to the positive test results of GM corynebacterium, antibiotics or antibiotics combined with steroid hormones were selected and compared with the usual clinical practice. Objective 1. To improve the detection method of Corynebacterium pyogenes and to improve the detection rate of Corynebacterium pyogenes; 2. To explore the influence of Corynebacterium infection on the clinical prognosis of patients with GM and to prove that Corynebacterium pyogenes is in GM. 3. To explore the clinical efficacy of antibiotics in patients with Corynebacterium infection and to guide the formulation of clinical drug regimens. Methods 1. To improve the detection rate of Corynebacterium by high-fat blood plate and PCR, and to detect different methods by comparing with the detection rate of common blood plate. Results 1. Detection of Corynebacterium granulomatosus mastitis: 24 cases of pus samples were divided into two repetitions: normal blood plate culture, the positive rate was 16.7. The positive rate of Corynebacterium was increased by 33.3%. The difference was statistically significant (P = 0.014). (2) 44 pus samples were divided into two repetitions: the positive rate of Corynebacterium Corynebacterium was 36.4% and the positive rate of C.K. Corynebacterium was 31.2%. PCR detection was performed. The positive rate of Corynebacterium was 50.0% and that of C.K was 45.5%. There was no significant difference between them. P=0.197.2. The significance of detection of Corynebacterium granulomatosus for clinical medication was as follows: (1) The positive rate of Corynebacterium was 59.3%, the negative rate was 40.7%, and the positive rate of C.K Corynebacterium was 54.7%. Negative rate was 45.3%. (2) Antibiotic regimens for GM patients infected with Corynebacterium included short-acting levofloxacin and azithromycin, long-acting anti-mycobacterium triple drug. (3) Follow-up of 42 cases, 21 cases were positive for Corynebacterium by PCR, and the recurrence rate was 23.5%. The efficacy of the three regimens was poor among GM patients infected with corynebacterium. P = 0.036. (4) Follow-up 42 cases, PCR detection of Corynebacterium negative 21 cases, postoperative recurrence rate of 16.7%. There was no significant difference between the two groups of different treatments for non-bacterial infection of GM patients, P = 0.719. Conclusion High-fat blood plate bacterial culture and PCR detection method is reliable, rapid detection of GM patients pus club shape. The early detection of Corynebacterium infection in GM patients is of great significance for clinical application of lipophilic antibiotics.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.8
【参考文献】
相关期刊论文 前2条
1 王颀;杨剑敏;于海静;;肉芽肿性乳腺炎的诊断与处理原则[J];中国实用外科杂志;2016年07期
2 刘双格;续哲莉;;人类乳腺炎性疾病细菌学研究[J];医学综述;2011年20期
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