特发性肉芽肿乳腺炎(idiopathic granulomatous mastitis,IGM),又称肉芽肿性小叶性乳腺炎、肉芽肿性乳腺炎,是一种局限于乳腺小叶、以非干酪样坏死性肉芽肿为主要病理特征的慢性炎症性疾病,近年来在全世界范围内呈爆发性增长,尤其是年轻女性,大多数患者来自地中海地区(如土耳其、约旦)和亚洲(如中国、马来西亚)[1].

Objective: To observe the clinical effect of precise minimally invasive debridement under the guidance of color ultrasound combined with Yiqi Heying Chinese medicinal in treatment of granulomatous mastitis（GM）, to study the therapeutic mechanism of Yiqi Heying Chinese medicinal from the angle of immunity, thus to establish an optimal diagnosing and treating scheme for GM with TCM internal and external therapies. Methods: A total of 100 female patients with GM who met the inclusion criteria were randomly divided into the treatment group and the control group, with 50 cases in each group. The treatment group was treated with precise minimally invasive debridement under the guidance of color ultrasound combined with Yiqi Heying Chinese medicinal, whereas the control group was treated with conventional incision and drainage of abscess combined with cortin and antibiotics. Both groups were treated for 8 weeks. The range of inflammatory lesions in the abscess cavity and surrounding breast, the cure rate, the total effective rate, the rebound rate, the recurrence rate, the effective rate of the conservative treatment, breast appearance evaluation and other indicators were observed in the two groups. The changes of erythrocyte sedimentation rate（ESR）, C-reactive protein（CRP）, complement C3 and C4, IgA, IgG and IgM were observed before and after the treatment in the two groups. Results: 48 cases were completed in the treatment group and 47 cases in the control group. The cure rate of the treatment group was 43. 75%（ 21/48）, which was significantly higher than 29. 79%（14/47） of the control group（P ＜ 0. 05）; the total effective rate of the treatment group was 89. 58%（ 43/48）, which was significantly higher than 72. 34%（ 34/47） of the control group（ P ＜ 0. 05）. The rebound rate was 0%（ 0/48） and the recurrence rate was 8. 33%（ 4/48） in the treatment group, which were significantly lower than 23. 40%（11/47） and 25. 53%（12/47） in the control group（P ＜ 0. 05）. After one week of treatment, the range of abscess cavity and surrounding inflammatory lesions decreased by 12%-15% in both groups, and the effect of the control group was faster than that of the treatment group（P ＜ 0. 05）. However, in the control group, 11 cases rebounded in the second week, and the range of the abscess cavity remained unchanged or even increased; in the treatment group, the range of inflammatory lesions in the abscess cavity and surrounding area decreased continuously（P ＜ 0. 05）. The conservative treatment efficiency was 93. 75%（ 45/48） in the treatment group, which was significantly higher than 59. 75%（ 28/47） in the control group（ P ＜ 0. 05）. Breast appearance evaluation results was better in the treatment group than that in the control group（ P ＜ 0. 05）. The levels of ESR, CRP, IgA, IgG and IgM were decreased after the treatment compared with those before the treatment in the two groups; the decreases in the treatment group were more significant than those in the control group（ P ＜ 0. 05）. The levels of complement C3 and C4 were increased after the treatment compared with those before the treatment in the two groups; the increase of C4 was more significant in the treatment group than that in the control group（ P ＜ 0. 05）. Conclusion: Under the guidance of color ultrasound, the cure rate and effectiveness of precise minimally invasive debridement combined with Yiqi Heying Chinese medicinal are significantly better than those of the therapy of conventional external treatment plus cortin and antibiotics in treatment of GM, which corrects the immune imbalance of patients, and has obvious advantages in shortening the onset time, narrowing the range of inflammation, reducing the rebound rate and the recurrence rate, improving the effectiveness of conservative treatment and the satisfaction of breast appearance. An internal and external treatment scheme for GM can be established based on TCM advantages.

目的:肿瘤相关抑郁发病率高、危害性大,中医治疗具有一定优势,本研究观察评价养心疏肝方防治靶向期HER-2阳性乳腺癌相关抑郁状态、缓解赫赛汀心脏毒性的临床优势.方法:采用前瞻性研究方法,选取山东中医药大学附属医院收治的HER-2阳性乳腺癌靶向治疗期的患者110例,随机分为对照组(赫赛汀组)55例和试验组(赫赛汀+养心疏肝方组)55例,观察周期为63日,以每个靶向治疗周期(21日)作为1个疗程,在第1、2两个疗程连续服用中药,第2疗程结束21日后进行随访,两组均在治疗前后进行中西医抑郁状态相关症状评分,并记录射血分数及安全性指标,采用重复测量资料分析统计学方法评估两组治疗抑郁相关状态的临床疗效.结果:与治疗前相比,治疗后中医症状总评分及各症状评分对照组呈升高趋势,试验组呈降低趋势,2组间差异具有统计学意义(P<0.05),HRSD24总积分及各症状积分组间比较均有统计学差异(P<0.05),HRSD24总积分组内对比,对照组第1疗程评分与治疗前相比无统计学差异(P>0.05),第2疗程及随访评分低于前1疗程,试验组治疗后评分均明显低于前1疗程,且试验组HRSD24总积分明显低于同期对照组,差异具有统计学意义(P<0.05).治疗前后比较,对照组射血分数有所减低,试验组射血分数均明显高于同期对照组.结论:养心疏肝方可明显减轻患者情绪抑郁、精神与躯体焦虑等相关症状,对Her-2阳性乳腺癌患者靶向治疗期相关抑郁状态具有防治效果,且远期效果显著.

目的:通过对初期特发性肉芽肿乳腺炎病例的观察,探讨益气和营方联合激素治疗的疗效和优势,同时初步验证外周血及病变组织中C3、C4免疫紊乱机制.方法:选取80例初期肉芽肿性乳腺炎患者,随机分为激素组、中药+激素组,每组40例.治疗期间定期观察乳房肿块大小、肿块疼痛评分,治疗后计算临床总有效率,治疗前后检测血清C3、C4水平,免疫组化法检测病变组织C3、C4阳性表达水平.结果:中药+激素组较激素组更有效缩小肿块、缓解疼痛(P<0.01),中药+激素组临床总有效率明显高于激素组(P<0.01),中药+激素组较激素组更能降低外周血C3、C4水平,更能降低病变组织内C3、C4的阳性表达水平(P<0.05).结论:中西医结合治疗特发性肉芽肿乳腺炎临床疗效显著,特发性肉芽肿乳腺炎外周血和局部病变组织内均存在C3、C4免疫紊乱,益气和营中药联合激素治疗可以更好地改善C3、C4免疫紊乱状态.