乳痈方调节乳腺菌群治疗哺乳期乳腺炎的临床研究

Clinical study on Ruyong Formula in treating lactational mastitis by regulating mammary gland flora

目的观察乳痈方治疗哺乳期乳腺炎的临床疗效及其可能的机制。方法对52例哺乳期乳腺炎患者予以中药乳痈方治疗,疗程为1周(7 d),并采用自身前后对照及自身双侧乳房对照的研究方法。观察比较治疗前后临床症状体征(乳房肿块、乳房胀痛、乳汁欠畅、乳腺局部皮色灼热、恶寒发热)评分的变化情况;并进行双侧乳房乳汁中各类致病菌、益生菌的定性、定量测定。结果(1)治疗前后比较,患者乳房肿块明显缩小(P<0.05),乳房胀痛明显缓解(P<0.05),乳汁欠畅明显改善(P<0.05),乳房局部皮色灼热明显缓解(P<0.05),恶寒发热明显好转(P<0.05)。(2)治疗前后比较,患侧乳汁中的致病菌明显减少(P<0.05)。(3)治疗前,患侧乳汁中与健侧乳汁中的葡萄球菌、链球菌、双歧杆菌、乳酸杆菌定量Ct值比较,差异无统计学意义(P>0.05)。(4)治疗前后同侧比较,患者两侧葡萄球菌及双歧杆菌、乳酸杆菌定量Ct值差异均有统计学意义(P<0.05);两侧治疗前后各类菌群Ct值差值比较,葡萄球菌Ct值差值患侧增多更明显,即葡萄球菌数量患侧减少更明显(P<0.05),双歧杆菌Ct值差值患侧减少更明显,即双歧杆菌数量患侧增多更明显(P<0.05),乳酸杆菌Ct值差值差异无统计学意义(P>0.05)。(5)链球菌感染患者本研究仅发现1例,其患侧乳汁中的链球菌数量存在减少趋势,双歧杆菌和乳酸杆菌的数量存在增多趋势。(6)治疗前后同侧比较,患者两侧双歧杆菌定量Ct值差异均有统计学意义(P<0.05),两侧乳酸杆菌定量Ct值差异无统计学意义(P>0.05);两侧治疗前后双歧杆菌Ct值差值比较,患侧减少更明显,即细菌数量患侧增多更明显(P<0.05),乳酸杆菌Ct值差值差异无统计学意义(P>0.05)。结论乳痈方治疗哺乳期乳腺炎的疗效满意,可明显缓解患者的临床症状体征,其机制可能是通过调节乳腺菌群(减少致病菌、增加益生菌)而起效。

Objective To observe the clinical efficacy of Ruyong Formula on lactational mastitis and its possible mechanism. Methods 52 patients with lactational mastitis were treated with Ruyong Formula,with a course of one week. A comparative study was conducted between treatment before and after and between bilateral breasts. The changes on the scores of clinical symptoms（ such as breast lump,breast distending pain,obstructed milk,local hot breast skin,aversion to cold with fever） were observed and compared before and after treatment. And the pathogenic bacteria and probiotics in milk of bilateral breasts were qualitatively and quantitatively determined. Results（1） Compared with treatment before,the breast lump was obviously reduced（ P〈0.05）,the breast distending pain was obviously alleviated（ P〈0.05）,the obstructed milk was obviously improved（ P〈0.05）,the local hot breast skin was obviously relieved（ P〈0.05） and the aversion to cold with fever was obviously improved（ P〈0.05） after treatment.（2）After treatment,the amount of pathogenic bacteria was significantly reduced in the milk of the affected side（ P〈0.05）.（3） Before treatment,there were no statistically significant differences on the quantitative Ct values of Straphylococcus,Streptococcus,Bifidobacteria and Lactobacilli in breast milk between the affected side and healthy side（ P〉0.05）.（4）For the Straphylococcus-infected patients,on the same side of breast（ affected or healthy side）,there were statistically significant differences on Ct values of Straphylococcus,Bifidobacteria and Lactobacilli between treatment before and after（ P〈0.05）.For the comparison of D-value on flora Ct values between treatment before and after,the D-value on Ct value of Straphylococcus was increased more obviously on the affected side, which meant that the amount of Straphylococcus was reduced more significantly on the affected side（ P〈0.05）. The D-value on Ct value of Bifidobacteria was decreased more obviously on the affected side,which meant that the amount of Bifidobacteria was increased more significantly on the affected side（ P〉0.05）. For the comparison of D-value on Ct value of Lactobacilli between treatment before and after,there was no statistically significant difference between the affected side and healthy side（ P〈0.05）.（5）Only one case infected with Streptococcus was found in this study. In the milk of affected side,the amount of Streptococcus showed the decreasing trend and the amount of Bifidobacteria and Lactobacilli showed the increasing trend.（6）For the non-bacteria mediated patients,on the same side of breast（ affected or healthy side）,there was statistically significant difference on the Ct value of Bifidobacteria between treatment before and after（ P〈0.05）,and there was no statistically significant difference on the Ct value of Lactobacilli between treatment before and after（ P〈0.05）. For the comparison of D-value on Ct value of Bifidobacteria between treatment before and after,the Ct value of Bifidobacteria was decreased more obviously on the affected side,which meant that the amount of Bifidobacteria was increased more significantly on the affected side（ P〈0.05）. For the comparison of D-value on Ct value of Lactobacilli between treatment before and after,there was no statistically significant difference between the affected side and healthy side（ P〉0.05）. Conclusion Ruyong Formula shows satisfactory efficacy in the treatment of lactational mastitis,which can significantly improve the clinical symptoms of patients. It may play the therapeutic role through regulating the mammary gland flora such as reducing pathogenic bacteria and increasing probiotics.