摘要
目的研究地塞米松穴位注射结合甲氨蝶呤用于治疗肉芽肿性乳腺炎的应用效果。方法采用前瞻性的研究模式,选取2021年1月至2024年1月南阳医学高等专科学校第一附属医院收治的80例肉芽肿性乳腺炎患者作为研究对象。采取随机数表法分为观察组和对照组,各40例。对照组接受口服抗生素与叶酸的同时,采用地塞米松穴位注射方式(每周每次每一穴位注射2.5mg)。观察组在对照组的常规治疗方案的基础上联合口服甲氨蝶呤(10mg甲氨蝶呤片,每周同一时间一次性口服)进行治疗。对比两组患者治疗效果、治疗前后血清学实验室指标[C反应蛋白(CRP)、白介素-6(IL-6)、白细胞(WBC)、病灶组织中CD68阳性表达情况]、乳房肿块变化时间和客观影像学指标(弹性平均值Emean、表观弥散系数平均值ADCmean、病灶体积),以及治疗过程中不良反应。结果治疗3个月后,观察组治疗有效率高于对照组,差异有统计学意义(P<0.05)。治疗3个月后,两组CRP、IL-6、WBC水平均低于治疗前,且观察组CRP、IL-6、WBC水平低于对照组,差异有统计学意义(P<0.05)。观察组治疗期间肿块缩小一半的时间及肿块完全消失时间均短于对照组,差异有统计学意义(P<0.05)。同时,治疗前两组患者的客观影像学指标比较,差异无统计学意义(P>0.05),治疗后两组患者各影像学指标均有明显改善(P<0.05),并且两组间对比,观察组患者的肿块以及Emean结果均明显小于对照组,而ADCmean明显高于对照组,差异有统计学意义(P<0.05)。治疗3个月后,两组CD68阳性表达评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组患者在治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论在常规治疗(抗生素、叶酸及地塞米松穴位注射)基础上加用甲氨蝶呤,较单纯常规治疗在3个月时可进一步改善CRP、IL-6、WBC与肿块相关结局,且未见不良反应总体发生率增加。
Objective To investigate the clinical efficacy of acupoint injection of dexamethasone combined with methotrexate in the treatment of granulomatous mastitis.Methods A prospective study was conducted on 80 patients with granulomatous mastitis admitted to the First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2024.Patients were randomly divided into an observation group and a control group(40 cases each)using the random number table method.The control group received oral antibiotics and folic acid in addition to acupoint injection of dexamethasone(2.5 mg injected into each acupoint once per week).The observation group was treated with oral methotrexate(10 mg once weekly at the same time)on the basis of the control group regimen.The treatment efficacy,serological laboratory indicators[C-reactive protein(CRP),interleukin-6(IL-6),white blood cell count(WBC)],CD68-positive expression in lesion tissue,changes in breast mass over time,objective imaging parameters[mean elasticity value(Emean),mean apparent diffusion coefficient(ADCmean),and lesion volume],as well as adverse reactions during treatment were compared between the two groups.Results After 3 months of treatment,the effective rate in the observation group was significantly higher than that in the control group(P<0.05).At 3 months,CRP,IL-6,and WBC levels in both groups were lower than before treatment,with the observation group showing significantly lower levels than the control group(P<0.05).The time(days)required for the breast mass to shrink by half and to completely disappear was shorter in the observation group than in the control group(P<0.05).Before treatment,there were no significant differences in objective imaging indicators between the two groups(P>0.05).After treatment,imaging indicators in both groups significantly improved(P<0.05),with the observation group showing significantly smaller mass size and Emean values,and significantly higher ADCmean values compared to the control group(P<0.05).After 3 months,CD68-positive expression scores in both groups were lower than before treatment,with the observation group showing significantly lower scores than the control group(P<0.05).The incidence of adverse reactions did not significantly differ between the two groups(P>0.05).Conclusion This single-center,randomized but non-blinded small-sample study suggests that adding methotrexate to conventional treatment(antibiotics,folic acid,and dexamethasone acupoint injection)can further improve CRP,IL-6,WBC,and mass-related outcomes at 3 months compared with conventional treatment alone,without increasing the overall incidence of adverse reactions.However,multicenter,blinded randomized controlled trials are still needed to verify its efficacy and long-term safety.
作者
张金锋
ZHANG Jinfeng(Department of Thyroid and Breast Surgery,The First Affiliated Hospital of Nanyang Medical College,Nanyang Henan 473000,China)
出处
《临床研究》
2025年第8期52-56,共5页
Clinical Research
关键词
地塞米松
甲氨蝶呤
肉芽肿性乳腺炎
抗生素
白细胞计数
Dexamethasone
Methotrexate
Granulomatous mastitis
Antibiotics
White blood cell count
作者简介
张金锋,男。研究方向:甲状腺乳腺疾病相关诊疗。
