■我们的荟萃分析的主要目的是评估特发性肉芽肿性乳腺炎(IGM)患者的各种治疗方式在成功缓解和预防复发方面的有效性。这些知识有助于为临床医生制定循证指南,以改善IGM患者的管理策略和结果。
■对MEDLINE(Ovid)进行了系统的文献检索,Embase(Elsevier),PubMed,科克伦图书馆,WebofScience,和谷歌学者;包括截至2022年1月19日发表的研究。对57项观察性研究进行了荟萃分析。还检查了两项随机对照试验的结果。
■观察性和随机研究中有3,035例IGM患者。59项研究中所有治疗策略的总复发率和缓解率分别为87.9%(2,667/3035)和13.5%(359/2667)。分别。研究报告了19种不同的治疗策略,包括观察,医学单一疗法,手术,以及涉及药物治疗的组合,有手术和没有手术。在单一疗法治疗中,手术治疗的合并缓解率最高(0.99[95%置信区间(CI)=0.97-1.00]);在联合治疗中,这是类固醇和手术(0.99[0.94-1.00])。抗生素单一疗法的缓解率最低(0.72[0.37-0.96])。复发率最高的是联合使用抗生素和手术的治疗(0.54[0.02-1.00]),和抗生素,类固醇,和手术(0.57[0.00-1.00])。预防复发最成功的是观察(0.03[0.00-0.10]),甲氨蝶呤(0.08[0.00-0.24]),和类固醇和手术(0.05[0.01-0.12])。较长的随访时间和报告的复发率之间存在显着关联,p=0.002。
■联合疗法,尤其是那些含有抗生素的,类固醇,和手术,表现出更高的缓解率,挑战抗生素单一疗法的使用。人们越来越重视个性化的需求,多管齐下预防IGM复发,有更长时间的后续护理。IGM研究中未来更多的前瞻性工作,具有标准化的诊断标准,治疗方案,和报告指南对于制定IGM患者的治疗方案和临床医生可以遵守的指南非常重要。系统审查注册:PROSPERO(CRD42022301386)。
UNASSIGNED: The major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM.
UNASSIGNED: A systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined.
UNASSIGNED: There were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97-1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94-1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37-0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02-1.00]), and antibiotics, steroids, and surgery (0.57 [0.00-1.00]). Most successful for preventing recurrence were observation (0.03 [0.00-0.10]), methotrexate (0.08 [0.00-0.24]), and steroids and surgery (0.05 [0.01-0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002.
UNASSIGNED: Combination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).