目的 探究曲安奈德联合泼尼松治疗肉芽肿性乳腺炎临床疗效。方法 选取2022年10月—2023年12月钦州市妇幼保健院收治的112例肉芽肿性乳腺炎女性患者，通过随机数字表法分为对照组（56例）和治疗组（56例）。对照组口服醋酸泼尼松片，从30 mg/d泼尼松开始以获得初始疾病控制，第1个月减量至20 mg/d，第2个月减量至10 mg/d，半个月减量至5 mg/d，直到治疗结束完全停药以防止症状反弹，治疗时间为3个月。治疗组在对照组基础上于病变中心注射醋酸曲安奈德注射液，每月注射1次20 mg/cm³，持续3个月。观察两组患者临床疗效，比较治疗前后两组患者乳房肿块大小及疼痛评分，及泌乳素（PRL）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、CD3^＋、CD4^＋、CD4^＋/CD8^＋、免疫球蛋白G（IgG）、IgM和IgA水平。结果 治疗后，治疗组患者总有效率为92.86%，显著高于对照组的75.00%（P＜0.05）。治疗后，两组肿块大小、疼痛评分均下降（P＜0.05），且治疗组显著低于对照组（P＜0.05）。治疗后，两组患者PRL、TNF-α、CRP、CD3^＋、CD4^＋、CD4^＋/CD8^＋、IgG、IgM、IgA水平均显著下降（P＜0.05），且治疗组这些指标较对照组降低更明显（P＜0.05）。结论 泼尼松联合曲安奈德治疗肉芽肿性乳腺炎患者有较好的临床疗效，能够缩小肿块大小，减轻疼痛，显著减轻患者炎症反应，抑制过度免疫应答，平衡患者免疫功能。

Objective To investigate the efficacy of triamcinolone combined with prednisone in treatment of granulomatous mastitis. Methods Patients (112 cases) with granulomatous mastitis in Qinzhou Maternal and Child Health Hospital from October 2022 to December 2023 were divided into control (56 cases) and treatment (56 cases) group by random number table method. Patients in control group were po administered with Prednisone Acetate Tablets, starting with 30 mg/d prednisone to achieve initial disease control, the dose was reduced to 20 mg/d in the first month, to 10 mg/d in the second month, and to 5 mg/d in the half month until the end of treatment was completely discontinued to prevent symptoms from rebounding. The treatment period was 3 months. Patients in treatment group were iv administered with Triamcinolone Acetonide Acetate Injection into the center of the lesion on the basis of the control group for 3 months, 20 mg/cm³, once a month. After treatment, the clinical evaluations were evaluated, the breast lump size and pain scores, the levels of PRL, TNF-α, CRP, CD3^＋, CD4^＋, CD4^＋/CD8^＋, IgG, IgM and IgA in two groups before and after treatment were compared. Results After treatment, the total effective rate of patients in the treatment group was 92.86%, which was significantly higher than 75.00% in the control group (P < 0.05). After treatment, the mass size and pain scores were decreased in two groups (P < 0.05), and which in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, the levels of PRL, TNF-α, CRP, CD3⁺, CD4⁺, CD4⁺/CD8⁺, IgG, IgM, and IgA in two groups were significantly decreased (P < 0.05), and these indicators in the treatment group were decreased more significantly than in the control group (P < 0.05). Conclusion The combination of prednisone and triamcinolone acetonide has good efficacy in treating granulomatous mastitis, which can reduce the size of the tumor, alleviate pain, obviously reduce the inflammatory response of patients, inhibit excessive immune response, balance the immune function.

R984

钦州市科学研究与技术开发项目（20231913）