| Background:Non-lactating mastitis is a mastitis disease whose incidence is increasing year by year.Clinically,it is characterized by repeated attacks and difficult to cure.Modern medicine has no particularly effective treatment.For the majority of patients,the characteristics of the disease are long,difficult to cure,and easy to recur and multiple sinus formation severely affect the patients' quality of life and increase the financial burden on their families.Surgery may lead to severe breast deformation or even a full breast cut,which seriously affects the aesthetics and has a great psychological impact on the patients.Therefore,non-lactating mastitis has become a disease that urgently needs to be studied and resolved.There are many clinical reports on the treatment of this disease by Chinese medicine,and each has its own unique advantages,but there is still no report on the exploration of mechanism of action.In clinical practice,our hospital has used Qingre Huatan Sanjie Recipe for the treatment of this disease for a long time.It has good clinical efficacy,but it lacks specific data to be supported.Therefore,based on the analysis and summary of the clinical risk factors of non-lactating mastitis,we further verified the clinical efficacy of Qingre Huatan Sanjie Recipe and explored the possible mechanism of Qingre Huatan Sanjie Recipe.This study also observes the clinical effects of glandular tissue immune indicators,NF-kBp65 expression intensity and VEGF content after treatment,in order to evaluate the effect of Qingre Huatan Sanjie Recipe on regulating the immune response of non-lactating mastitis to control the progression of disease and promote inflammation.Objective:To explore the clinical effect of Qingre Huatan Sanjie Recipe on inhibiting the local tissue immune response and promoting inflammation subsidence in non-lactating mastitis,and explore its possible mechanism.Methods:Based on the risk factors for non-lactating mastitis:BMI,nipple discharge,nipple depression,number of abortions,and prolactin levels,this study compared 60 cases of non-lactating mastitis with 60 healthy women.Based on the principle of randomized control,60 non-lactating mastitis patients were divided into a treatment group and a control group,with 30 cases in each group.Both groups of patients were diagnosed as non-lactating mastitis by pathology.The study was approved by the ethics committee and the patients' informed consent was obtained.The age of the treatment group was 33.26±8.55 years,the course of disease was 34.56±31.67days;the age of the control group was 34.63±7.44 years,the course of disease was 3 3.23±31.02days;The diameter of the mass of the treatment group:1 case was less than 2cm,7 cases were 2cm or more and less than 4cm,6 cases were 4cm or more and less than 5cm,16 cases were 6cm or more;3 cases of localized breast with red skin,11 cases with bright red skin,and slightly 8 cases were red,and 8 cases were purple or dark red.The diameter of the mass of the control group:1 case was less than 2cm,5 cases were 2cm or more and less than 4cm,5 cases were 4cm or more and less than 5cm,19 cases were 6cm or more;4 cases of localized breast with red skin,13 cases with bright red skin,and slightly 6 cases were red,and 7 cases were purple or dark red.The control group was given comprehensive treatments such as antibiotics,surgical dressing changes(1 time/day),microwave treatment frequency(2 times/day),and topical application of Qingbao San(2 times/day).The treatment group was given Qingre Huatan Sanjie Recipe on the basis of general comprehensive treatment,each Chinese medicine prescription was fried into 200ml decoction,100ml orally twice a day.The course of treatment is one month,and the time of observation:fill in the clinical symptoms and signs observation scores on the 1st and 30th days of treatment,perform puncture biopsy on inflammatory glandular tissues in patients with masses,incision and drainage of abscesses and sinus replacement.Partial glandular tissues were cut from the patients during the drug change,and the concentrations of IgG,IgM,and VEGF were measured by enzyme-linked immunosorbent assay.The intensity of CD4+,CD8+,and NF-kBp65 expression was detected by immunohistochemistry.Results:1.Risk factors:The BMI value of patients with non-lactating mastitis is 17.33?35.29,with an average of 24.8±4.046.54.1%of patients in the non-lactating mastitis group were overweight or underweight.Compared with the health checkers group during the same period,there was a statistical difference(p<0.05).In the non-lactating mastitis group,38.33%of patients had nipple depression,which was higher than that of health checkers,but there was no statistical significance(P>0.05).In non-lactating mastitis group,25%of patients had high levels of prolactin in the peripheral blood,while only 10%of patients in the health checkers had high levels of prolactin.However,there was no statistical significance in the two groups(P>0.05)2.Clinical symptoms,physical scores and efficacy:After 1 month of treatment,the pain score and redness score(1.53±1.45,1.60±1.52)in the treatment group were significantly lower than those in the control group(2.60±1.83,2.66±1.91)(P<0.05),which was statistically significant.After treatment,the mass diameter score of the treatment group(4.00±2.16)was significantly lower than that of the control group(2.40± 1.92),which had significant statistical significance(P<0.01).The sinus score(1.20±1.15)in the treatment group was not statistically significant compared with the control group(1.23±1.16)(P>0.05).Overall effect:In the treatment group,5 cases were cured,8 cases were markedly effective,13 cases were effective,and 4 cases were ineffective.The total efficacy rate was 86.67%.In the control group,2 cases were cured,4 cases were markedly effective,10 cases were effective,and 14 cases were ineffective.The total response rate was 53.33%.The clinical efficacy score of the treatment group(3.73±1.55)was statistically significant compared with the control group(2.20±1.60)(P<0.05).3.Before treatment,non-lactating mastitis patients with simple masses had the highest IgM and IgG content,and those with sinus tract had the lowest IgM and IgG content;while those with abscess(ulcer)had the highest VEGF content and those with simple mass had the lowest VEGF.After treatment,the contents of IgM(51.45±25.78 ug/g)and IgG(996.23±331.17 ug/g)in the tissues of the treatment group were significantly lower than those in the control group(69.68±25.25 ug/g,1404.45±464.77 ug/g)(P<0.05),and the content of VEGF(263.41±215.99 ug/g)was significant lower than that of the control group(491.14±323.65 ug/g)(P<0.01),all were statistically significant.4.CD4+T,CD8+T in inflammatory tissues:In the treatment group,the CD4+T immunohistochemical score(2.70±2.31)of the inflammatory tissue was significantly lower than that of the control group(5.70±3.34),and the CD8+T immunohistochemical score(9.80±4.47)was significantly higher than that of the control group(5.40±2.90).All of them have statistical significance(P<0.05).High power microscope pathological section:Before treatment,non-lactating mastitis gland interstitial cells showed deeper CD4+T and CD8+T positive staining,a higher proportion of CD4+T positive cells,a lower proportion of CD8+positive cells and the ratio of CD4/CD8 is high.After treatment,the staining of CD4+T-positive cells becomes lighter,the proportion of CD4+T-positive cells decreases,the staining of CD8+T-positive cells is deep,the proportion of CD8+T-positive cells increases and the ratio of CD4/CD8 decreases.5.NF-kBp65 in inflammatory tissues:After treatment,the NF-kBp65 immunohistochemical score of inflammatory glandular tissues in the treatment group(2.07±0.97)was significantly lower than that in the control group(4.26±0.65),which was statistically significant(P<0.05)).Pathological sections under high magnification:Before treatment,the cytoplasm or nucleus of non-lactating mastitis mammary duct endothelial cells in the treatment group showed scattered or aggregated brown-yellow particles with deep staining and strong NF-kBp65 expression.After treatment,only a few brown-yellow particles were deposited in the membrane or cytoplasm,and the staining was light,and the expression of NF-kBp65 was weak.Conclusion:1.Observation of general risk factors for non-lactating mastitis shows that overweight or obesity,hyperprolactinemia,and abortion are closely related to non-lactating mastitis to a certain extent,all of which are worth living and clinical attention and need to take Nursing,diet guidance,changing bad lifestyle habits,exercise to lose weight,proper breastfeeding time,avoid abortion and other measures.Early intervention and early prevention have certain significance for reducing the incidence of non-lactating mastitis.2.Qingre Huatan Sanjie Recipe can obviously alleviate the symptoms of breast pain in patients,promote the redness and swelling of breast skin,reduce the mass and lighten the sinus tract,reduce the patient's pain and improve the clinical efficacy.The prescription is worthy of clinical promotion and further research.3.Qingre Huatan Sanjie Recipe can significantly reduce the content of IgM and IgG in non-lactating mastitis tissues,and effectively reduce the primary humoral immune response and re-immune response in inflammatory tissues,thereby reducing the damage of immune response to glandular tissues.Qingre Huatan Sanjie Recipe can attenuate the expression of CD4+T and enhance the expression of CD8+T,and then suppress the T lymphocyte-mediated immune response in non-lactating mastitis tissues,and enhance the body's immunity to a certain extent.Finally,it can reduce the clinical symptoms and signs of non-lactating mastitis and promote recovery.4.Qingre Huatan Sanjie Recipe can attenuate the expression of NF-kBp65 in glandular tissues of non-lactating mastitis,and its inhibition of tissue inflammation and immune regulation may be achieved by regulating the activation of NF-kBp65 pathway. |
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