Clinical Study Of Xiaoyong Sanjie Formula Combined With External APPlication Of Medicine Residue In The Treatment Of Plasma Cell Mastitis In The Ulcerative Stage And A Reliminary Mechanism Study

Plasma cell mastitis(PCM)is a refractory chronic aseptic inflammation characterized by duct dilation and surrounding inflammatory cell infiltration.PCM has a wide age range,and is prone to be ulcerative or even formation of multiple lesions,which is difficult to heal and has a long course of disease.For the ulceration type,the current western medicine treatment is still based on surgery,incision and drainage and debridement and dressing change,while the traditional Chinese medicine treatment is oral and external treatment,the curative effect is significant,while reducing the damage to the shape of the breast.Based on the previous research,this study took PCM at the ulceration stage as the research target.By observing the treatment of patients with PCM at the ulceration stage by traditional Chinese medicine and eploring the relevant signal pathways of PCM rats,the efficacy of oral Chinese medicine combined with external application of residues and the possible mechanism of the influence of PCM on rats were discussed.In order to provide reference for the study of the intervention effect and mechanism of traditional Chinese medicine on PCM.There are three parts,literature review,clinical and basic research.1.Literature reviewBy sorting out the current mechanism research literature,the inflammatory immune factors and signal pathways related to PCM were explored to explore the possible pathogenesis of PCM.By reviewing and summarizing PCM related Chinese medicine literature,we can understand the etiology and pathogenesis of PCM in Chinese medicine,as well as the current status and research progress of the treatment of PCM in Chinese medicine.2.Clinical researchObjective:To observe the clinical efficacy and safety of Xiaoyong Sanjie Formula combined with external application of drug residue in the treatment of plasma cell mastitis in the ulcerative stage.Methods:In this study,128 patients with plasma cell mastitis at the ulcerative stage were divided into control group(n=64)and experimental group(n=64)by envelope method.The control group was given Xiaoyong Sanjie formula orally,and the experimental group was given Xiaoyong Sanjie formula combined with residue external application.The treatment course of both groups was 4 months.At baseline,1 month,2 months and 4 months of treatment,the size of ulcer,healing rate,syndrome score table and safety indicators were recorded.Results:Within 4 months,55 cases(85.94%)of the experimental group healed,while 53 cases(85.48%)of the control group healed.There was no significant difference between the two groups(P>0.05).The mass reduction score of the two groups before and after treatment was different(P<0.05),and the experimental group was better than the control group(P<0.05).There were no adverse reactions in the two groups.Conclusion:1.Xiaoyong Sanjie formula combined with external application of detumescence block has more obvious effect;2.Xiaoyong Sanjie formula is safe and effective in the treatment of plasma cell mastitis at the ulceration stage,which can be used for clinical promotion.3.Basic researchObjective:By observing the effect of Xiaoyong Sanjie formula on experimental Plasma cell mastitis rats,the inflammatory and immune mechanism of Xiaoyong Sanjie formula was discussed.Methods:Fifty female SPF Wistar rats were numbered and randomly divided into five groups by random number table method:①In the sham operation group,the same mammary tissue of the rats was injected with 0.2 mL normal saline,and the same volume of distilled water was gavaged ingastric;②In model group,equal amount of distilled water was intragastric;③Western medicine control group.prednisone acetate(2.70mg/kg body weight)+metronidazole(108 mg/kg body weight);④Xiaoyong Sanjie formula high-dose group,5.0g crude drug/kg;⑤Xiaoyong Sanjie formula low-dose group.1.7g crude drug/kg,gavage time of 28d.Establishment of experimental plasma cell mastitis rat model Methods:The plasma cell mammary disease tissues of patients were injected into the 3rd to 4th pair of mammary tissues of rats.On day 29,blood was collected from abdominal aorta of rats after anesthesia.T lymphocyte subsets(CD3+,CD4+,CD8+)were detected by flow cytometry,serum immunoglobulin(IgA/IgG/IgM)was detected by colorimetry,hormone levels(LH,T,E2,P,PRL),IL-2,IL-6 were detected by ELISA.The protein expressions of p-NFKBP65,p-IkBα,IL-6,p-JAK2K and p-STAT3 were detected by Western Blot.Breast tissue sampling:HE staining was used to observe the pathological status.Results:HE staining showed that Xiaoyong Sanjie formula significantly improved the pathological morphology of plasma cell mastitis rats.Compared with the sham surgery group,the model group E2 was significantly increased(P<0.05),IgG decreased,p-NF-KBP65,pIkBα,IL-6,p-JAK2K,p-STAT3 protein expression increased(P<0.05,P<0.05).compared with the model group,the double positive T cells in Xiaoyong Sanjie formula high-dose group were significantly increased(P<0.05),and the Xiaoyong Sanjie formula low-dose group IgG was significantly reduced(P<0.05),and the E2 and IL-2 in the Xiaoyong Sanjie formula high-dose group were significantly increased compared with the model group.IL-6 was significantly reduced(P<0.05,P<0.05),and the expression of p-JAK2 and p-STAT3 proteins was reduced(P<0.05).Conclusion:Xiaoyong Sanjie Formula has a good therapeutic effect on plasma cell mastitis model rats,and its mechanism may be related to correcting endocrine disorders,regulating immune function,inhibiting NF-κB and IL-6/JAK2/STAT3 signaling pathway.