脓肿型肉芽肿性乳腺炎病原学特点及NLRP3和IL-1β表达变化

Etiological characteristics of abscessed granulomatous mastitis and changes of NLRP3 and IL-1β

目的探讨脓肿型肉芽肿性乳腺炎(GM)病原学特点及Nod样受体家族含有pyrin结构域蛋白3(NLRP3)炎症小体和白细胞介素(IL)-1β表达变化。方法选取2016年6月-2021年6月南方医科大学附属东莞医院收治的84例GM患者为研究对象,记录脓肿型GM占比及感染病原学特点,检测GM患者外周血C-反应蛋白(CRP)水平、IL-2、IL-8和IL-6水平及乳腺病变组织NLRP3、凋亡相关斑点样蛋白(ASC)、半胱氨酸蛋白酶1(caspase-1)和IL-1β水平,分析其临床意义。结果38例(45.24%)脓肿型GM患者共分离病原菌32株,主要为棒状杆菌,其中水生棒状杆菌9株、微小棒状杆菌8株、G群棒状杆菌5株、杰氏棒状杆菌4株;29株棒状杆菌对克林霉素耐药率较高,对庆大霉素、利奈唑胺、万古霉素均敏感。与非脓肿组相比,脓肿组外周血CRP、红细胞沉降率(ESR)、催乳素(PRL)、IL-2、IL-8、IL-6水平及乳腺组织NLRP3、ASC、caspase-1和IL-1β水平均升高(P<0.05);NLRP3、ASC、caspase-1、IL-1β及其联合鉴别诊断脓肿型GM的曲线下面积分别为0.795、0.799、0.754、0.757和0.932。结论脓肿型GM病原菌以棒状杆菌为主,对庆大霉素、利奈唑胺、万古霉素均敏感,NLRP3炎症小体和IL-1β表达增强,且对脓肿型GM有良好的鉴别效能。

OBJECTIVE To explore the etiological characteristics of abscessed granulomatous mastitis(GM)and analyze the changes of expressions of Nod-like receptor family pyrin domain-containing protein 3(NLRP3)inflammasome and interleukin-1β(IL-1β).METHODS A total of 84 patients with GM who were treated in Dongguan Hospital Affiliated to Southern Medical University from Jun 2016 to Jun 2021 were recruited as the research subjects.The proportions of the patients with abscessed GM and the etiological characteristics were recorded.The levels of C-reactive protein(CRP),IL-2,IL-8 and IL-6 in peripheral blood as well as expression levels of NLRP3,apoptosis-associated speck-like protein containing CARD(ASC),cysteine proteinase 1(caspase-1)and IL-1βin breast tissues were detected,and the clinical significance was observed.RESULTS Totally 32 strains of pathogens were isolated from 38(45.24%)patients with abscessed GM,among which Corynebacteria were dominant,there were 9 strains of Corynebacterium aquaticum,8 strains of Corynebacterium parvum,5 strains of Corynebacterium G and 4 strains of Corynebacterium jeikeium.The drug resistance rate of the 29 strains of Corynebacteria to clindamyzin was relatively hhigh,while the strains were sensitive to gentamycin,linezolid and vancomycin.The levels of peripheral blood CRP,erythrocyte sedimentation rate(ESR),prolactin(PRL),IL-2,IL-8 and IL-6 as well as the expression levels of breast tissue NLRP3,ASC,caspase-1 and IL-1βwere higher in the abscess group than in the non-abscess group(P<0.05).The areas under curves(AUCs)of NLRP3,ASC,caspase-1,IL-1βand their combination were respectively 0.795,0.799,0.754,0.757 and 0.932 in differential diagnosis of abscessed GM.CONCLUSION Corynebacteria are dominant among the pathogens isolated from the patients with abscessed GM and are sensitive to gentamycin,linezolid and vancomycin.The expression levels of NLRP3 inflammasome and IL-1βare elevated,which has favorable efficiency in differential identification of abscessed GM.