正常女性乳头凹陷小样本配对前瞻性调查—浆细胞乳腺炎发病机制的研究

A prospective study on the paired samples of normal female nipple depression —Study on pathogenesis of plasma cell mastitis

目的:探讨乳头凹陷在浆细胞乳腺炎发病机制中的作用和地位。方法:前瞻性调查北京五洲妇儿医院2015年10月—2016年4月门诊乳腺体检人群2005例,配对调查51例乳头凹陷组和对照组在初潮、怀孕、分娩、乳头凹陷、哺乳时间、浆细胞乳腺炎手术史和母亲乳头凹陷史。统计分析采用Pearson x2检验,t检验。结果:2005例女性乳腺体检乳头凹陷占2.54%,进行过浆细胞乳腺炎手术占0.15%;51例乳头凹陷组,Ⅰ级乳头凹陷37.25%,Ⅱ级43.14%,Ⅲ级19.6%;左侧乳头凹陷25.49%,右侧31.37%,双侧43.14%;乳头凹陷组产后没有哺乳占68.63%,对照组没有哺乳11.26%,其中乳头凹陷2级3级产后没有哺乳占87.5%;乳头凹陷组母亲有乳头凹陷,占7.84%;年龄、初潮、怀孕、分娩配对两组差异。结论:乳头凹陷是常见乳头异常表现,显著影响产后哺乳,家族遗传性低。乳头凹陷是乳腺乳管瘀滞的重要原因,在浆细胞乳腺炎发病机制中占有重要的基础性地位。笔者提出浆细胞乳腺炎发病三阶段理论,乳管瘀滞期,乳管免疫炎症期,乳管腺体破坏期。乳头凹陷参与浆细胞乳腺炎发病机制第一阶段,乳头凹陷是乳管瘀滞期主要致病因素。在机体其他致病因素共同作用下,进入浆细胞乳腺炎的临床阶段和加重阶段。

Objective： To explore the function and position of the inverted nippie in the pathogenesis of plasma cell mastitis. Methods： Prospective study of 51 cases of inverted nipples in paired control from 2005 subjects of clinic health screening from October 2015 to 2016 April was made, the menarche age, number of pregnancy and deliver; time： of nursing, operation history of plasma cell mastitis and inheritance, inverted nipples of mother of two groups were paired and compared. Pearson χ2 test was used for statistical analysis. Results： Inverted nipples were found in 51 cases from 2005 women, 2.54% in all;. Operation of plasma cell mastitis was confirmed in 3 cases, 0.15% in all. In inverted nipple group, Grade l, Grade 2 and Grade 3 inverted：nipple rate was 37.25%, 43.14% and 19.6% respectively, the left inverted nipple rate, right inverted nipple rate and bilateral inverted nipple rate was 25.49%, 31.31% and 43.14% respectively. The percentage of no breast feeding in two groups was 68.63% and 11.26% respectively. The percentage of no breast feeding in Grade 2 and 3 of inverted group was up to 87.5% and that of the inverted nipple＇group was 7.84%; There were no difference in ages, menarche, number of pregnancy and deliver. Conclusion： The inverted nipples was a frequent disorder in adult women, which severely affect the breast feeding, its family inheritance was low. Inverted nipple was the main reason on stasis of lactating ducts, it played an important role in early stage ofpathogenesis of plasma cell mastitis. The author suggested a hypothesis that the pathogenesis of plasma cell mastitis had three phases, that is, stasis of lactating ducts; immune-inflammation of laotafing ducts and destroy of lactating ducts and mammary tissue; Inverted nipple was related to the first phase ofpathogenesis, stasis of lactating ducts. Combined with others pathogenic factors, it proved to be plasma cell mastitis in the phases of immune-inflammation and destroy of lactating ducts.