棒状杆菌感染的肉芽肿性小叶性乳腺炎临床特征分析

发布时间：2019-05-23 23:32

【摘要】：目的:对比分析棒状杆菌感染的肉芽肿性小叶性乳腺炎患者与非棒状杆菌感染患者之间的临床特征,探寻两者之间的差异性,提高对此类患者临床特征的认识。方法:采用回顾性临床资料对比分析方法,将我院2015年1月-2016年9月住院经病理诊断为肉芽肿性小叶性乳腺炎(GLM)且行细菌培养的患者分为两组,A组:非棒状杆菌感染的肉芽肿性小叶性乳腺炎患者;B组:棒状杆菌感染的肉芽肿性小叶性乳腺炎患者。将两组患者的病例资料建立数据库,运用X2检验、秩和检验、Fisher确切概率法等统计方法,探讨棒状杆菌感染的GLM患者与非棒状杆菌感染者之间临床特征的差异性以及可能影响菌培结果相关因素,得出结论。结果:1.一般情况棒状杆菌感染的GLM患者的发病距末次生产时间平均为4.09±2.50年,与非棒状杆菌感染者(3.98±4.82年)相比,棒状杆菌感染者的发病距末次生产的时间更长,差别有统计学意义(P0.05)。棒状杆菌感染的GLM患者的平均发病年龄、发病年龄的构成比、生育次数、哺乳时长、发病距末次哺乳时间、哺乳期间有无乳腺炎、患侧乳房外伤史、口服避孕药史、抑郁症病史方面均无明显差异(P0.05)。2.临床表现棒状杆菌感染的GLM患者的肿块大小平均为7.24±2.89cm,比非棒状杆菌感染者的肿块明显更大(6.42±2.82cm),且差别有统计学意义(P0.05)。棒状杆菌感染的GLM患者可出现乳头短小或凹陷及乳头溢液,单侧或双侧乳房均可发病,皮肤潮红肿胀,初起肿块集中于外周象限,疼痛与肿块并存,在发病过程中可出现发热及四肢红斑,以上表现与非棒状杆菌感染者相似(P0.05)。3入院时的临床分型、分期及辨证棒状杆菌感染的GLM患者入院时的临床分型分期中主要为脓肿型、急性期,入院时初期临床辨证多见热毒炽盛。与非棒状杆菌感染者相比,差异无统计学意义(P0.05)。4.其他指标棒状杆菌感染的GLM患者再次入院率高于非棒状杆菌感染者,差异有统计学意义(P0.05)。棒状杆菌感染的GLM患者伴高泌乳素血症的情况,与非棒状杆菌感染者相比,差异无统计学意义(P0.05)。棒状杆菌感染的GLM患者取材距离发病的时长平均为2.02±2.12月,与非棒状杆菌感染者相比,合并棒状杆菌感染者更短,差别有统计学意义(P0.01)棒状杆菌感染的GLM患者取材时的分型分期多为脓肿型、急性期,以脓液为主,与非棒状杆菌感染者相比无差异。结论:棒状杆菌感染的GLM患者发病距离末次生产的时间更长,肿块相对较大,再次入院率更高。棒状杆菌感染的GLM患者取材距离发病的时长更短,提示我们发病早期可能更有利于棒状杆菌的检出,距离末次生产时间越久,乳腺导管内的生理变化可能更有利于细菌的生长。但两组间的临床特征大部分未见明显差异,考虑棒状杆菌感染的GLM不一定是一种特殊的乳腺炎。
[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 卤2.5 years. Compared with non-Corynebacterium infection (3.98 卤4.82 years), the onset time of Corynebacterium infection was longer than that of non-Corynebacterium infection (3.98 卤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 卤2.89 cm, which was significantly larger than that of non-Corynebacterium infection patients (6.42 卤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 卤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.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.8

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