疏肝清热化瘀方联合地塞米松对浆细胞性乳腺炎患者炎症细胞因子和乳房疼痛的影响

Effect of Shugan Qingre Huayu prescription combined with dexamethasone on inflammatory factors and breast pain in patients with plasma cell mastitis

目的观察疏肝清热化瘀方联合地塞米松对浆细胞性乳腺炎患者炎症细胞因子和乳房疼痛的影响。方法选取2021年1月—2023年1月在嘉兴市中医医院就诊的100例浆细胞性乳腺炎患者为研究对象,将患者随机分为地塞米松组50例和联合组50例。地塞米松组患者采用地塞米松治疗,联合组患者在地塞米松组基础上联合使用疏肝清热化瘀方治疗,比较两组患者临床体征、症状积分、免疫指标、炎症细胞因子、不良反应、复发率及临床疗效的差异。结果两组患者治疗前的肿块大小、乳房疼痛及皮肤红肿积分比较,差异均无统计学意义(均P>0.05);治疗后,两组患者的肿块大小、皮肤红肿及乳房疼痛积分均有所降低,且联合组患者[(1.27±0.49)分、(0.97±0.31)分及(0.82±0.37)分]均明显低于地塞米松组[(2.33±0.71)分、(2.15±0.76)分及(1.95±0.65)分],差异均有统计学意义(t=8.689、10.170及10.680,均P<0.05)。治疗前两组患者的免疫指标表达水平比较,差异均无统计学意义(均P>0.05);治疗后,两组患者IgM、IgA及IgG水平均下降,且联合组患者[(1.26±0.30)g/L、(1.73±0.46)g/L及(6.74±1.31)g/L]下降幅度大于地塞米松组[(2.03±0.51)g/L、(2.73±0.70)g/L及(10.53±2.08)g/L],差异均有统计学意义(t=9.202、16.880及10.900,均P<0.05)。两组患者治疗前炎症细胞因子表达水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者CRP、IL-6及TNF-α水平均降低,且联合组患者[(8.56±2.60)mg/L、(1.73±0.59)ng/L及(53.82±11.26)μg/L]降低幅度大于地塞米松组[(18.68±3.48)mg/L、(5.37±1.10)ng/L及(76.14±15.30)μg/L],差异均有统计学意义(t=16.470、20.620及8.308,均P<0.05)。两组患者不良反应发生率(12.00%vs.4.00%)比较,差异无统计学意义(χ^(2)=2.174,P>0.05);联合组较地塞米松组患者的复发率(34.00%vs.10.00%)降低,差异有统计学意义(χ^(2)=8.392,P<0.05)。联合组患者治疗的总有效率(72.00%vs.96.00%)高于地塞米松组,差异有统计学意义(χ^(2)=6.000,P<0.05)。结论疏肝清热化瘀方联合地塞米松治疗浆细胞性乳腺炎效果明显,可有效改善浆细胞性乳腺炎患者的相关临床症状,减轻乳房疼痛感,降低炎症细胞因子水平,调节机体免疫功能,加快疾病恢复。

Objective To observe the effects of Shugan Qingre Huayu recipe combined with dexamethasone on inflammatory factors and breast pain in patients with plasma cell mastitis.Methods A total of 100 patients with plasma cell mastitis treated in Jiaxing Hospital of Traditional Chinese Medicine from January 2021 to January 2023 were selected as the study objects,and the patients were randomly divided into dexamethasone group and combined group,with 50 cases in each group.The dexamethasone group was treated with dexamethasone,and the combined group was treated with Shugan Qingre Huayu prescription on the basis of the dexamethasone group.The differences of clinical signs,symptom scores,immune indexes,inflammatory cytokines,adverse reactions,recurrence rate and clinical efficacy were compared between the two groups.Results There were no significant differences in tumor size,breast pain and skin redness scores between the two groups before treatment(all P>0.05).After treatment,the tumor size,skin redness and breast pain scores of both groups were decreased,and the combined group[(1.27±0.49)points,(0.97±0.31)points and(0.82±0.37)points]were significantly lower than the dexamethasone group[(2.33±0.71)points,(2.15±0.76)points and(1.95±0.65)points]the differences were statistically significant(t=8.689,10.170 and 10.680,all P<0.05).There was no statistically significant difference in the expression levels of immune indicators between the two groups of patients before treatment(all P>0.05).After treatment,the levels of IgM,IgA,and IgG in both groups of patients decreased,and the decrease in the combined group[(1.26±0.30)g/L,(1.73±0.46)g/L,and(6.74±1.31)g/L]was greater than that in the dexamethasone group[(2.03±0.51)g/L,(2.73±0.70)g/L,and(10.53±2.08)g/L]with statistical significance(t=9.202,16.880,and 10.900,all P<0.05).There was no statistically significant difference in the expression of inflammatory cytokines between the two groups of patients before treatment(all P>0.05).After treatment,CRP,IL-6,and TNF-αin both groups all decreased,and the combined group patients[(8.56±2.60)mg/L,(1.73±0.59)ng/L,and(53.82±11.26)μg/L]was greater than that in the dexamethasone group[(18.68±3.48)mg/L,(5.37±1.10)ng/L and(76.14±15.30)μg/L],the differences were statistically significant(t=16.470,20.620,and 8.308,all P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients(12.00%vs.4.00%)(χ^(2)=2.174,P>0.05);the recurrence rate of the combined group was significantly lower than that of the dexamethasone group(34.00%vs.10.00%),and the difference was statistically significant(χ^(2)=8.392,P<0.05).The total effective rate of treatment in the combined group(72.00%vs.96.00%)was higher than that in the dexamethasone group,and the difference was statistically significant(χ^(2)=6.000,P<0.05).Conclusion Shugan Qingre Huayu prescription combined with dexamethasone has obvious effect in the treatment of plasma cell mastitis,which can effectively improve the related clinical symptoms of patients with plasma cell mastitis,relieve breast pain,reduce the level of inflammatory cytokines,regulate the immune function of the body,and accelerate the recovery of the disease.