■尽管肉芽肿性小叶性乳腺炎(GLM)的发病率上升,其病因和诱发因素的不确定性仍然存在,无法指导临床治疗和早期预防。本研究的目的是探讨GLM的诱发因素。
■这项病例对照研究于2018年至2021年在北京中医医院进行,首都医科大学。根据性别和居住面积,将GLM患者(病例)与健康受试者(对照)以1:1的比例进行匹配。我们分析了他们的人口统计学特征,并使用标准问卷调查了可能与GLM相关的75个因素。使用单变量和多变量二元条件逻辑回归分析比较两组之间的差异,并评估可能导致GLM的诱发因素。
■该研究包括594名女性GLM患者和594名匹配的对照。病例平均年龄为32.78岁(主要为20~40岁)。分娩后五年内发病率很高,病变主要在单侧乳腺。单变量和多变量条件逻辑回归分析获得了六个相关因素和六个高危因素。六个相关因素包括年龄,婚姻,情绪异常,高催乳素,精神药物的摄入量,和性激素的摄入。此外,GLM的独立高危因素包括妊娠,乳头内陷,钝性外伤,非医源性按摩,泌乳障碍,乳头溢液(比值比(OR)=17.378、8.518、4.887、3.116、2.522、1.685,P<0.05)。绝经是独立的保护因素(OR=0.249,P<0.05)。
■增加乳汁和乳腺导管分泌的因素是GLM的主要危险因素,尤其是乳头内陷的时候.这些因素可以阻塞导管并引起炎症。此外,荷尔蒙失调,外在创伤,情绪异常可加速GLM的发生。
UNASSIGNED: Despite the rising incidence rate of granulomatous lobular mastitis (GLM), uncertainties persist about its etiologic and predisposing factors to guide clinical treatment and early prevention. The objective of this study is to explore the predisposing factors for GLM.
UNASSIGNED: This
case-control study was conducted from 2018 to 2021 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. Patients with GLM (cases) were matched with healthy examinees (controls) in a 1:1 ratio according to gender and living area. We analyzed their demographic features and investigated 75 factors that may be relevant to GLM using a standard questionnaire. Univariate and multivariable binary conditional logistic regression analyses were used to compare the differences between the two groups and evaluate the predisposing factors that may induce GLM.
UNASSIGNED: There were 594 female GLM patients and 594 matched controls included in the study. The average age of the cases was 32.78 years (mainly 20 to 40). The incidence was high within five years after childbirth, and lesions were mainly in the unilateral breast. Univariate and multivariable conditional logistic regression analyses obtained six relevant factors and six high-risk factors. The six relevant factors included age, marriage, emotional abnormality, high prolactin, psychiatric drug intake, and sex hormone intake. Additionally, the independent high-risk factors for GLM included gestation, nipple invagination, blunt trauma, non-iatrogenic massage, lactation disorder, and nipple discharge (odds ratio (OR)=17.378, 8.518, 4.887, 3.116, 2.522, 1.685, P<0.05). Menopause was an independent protective factor (OR=0.249, P<0.05).
UNASSIGNED: The factors that increase milk and secretion production in the mammary duct are the main risk factors of GLM, especially when the nipples are invaginated. These factors can obstruct the duct and induce inflammation. Additionally, hormonal disorders, extrinsic trauma, and emotional abnormalities can accelerate the occurrence of GLM.