Curative Effect Of Tuolitouyu Decoction In The Treatment Of Granulomatous Mastitis And Its Influence On Inflammatory Factors In Lesions

Background:Granulomatous lobular mastitis(GLM)is a non-lactation mastitis disease that has been increasing incidence rate and has been paid more and more attention in recent years.Although it does not cause fatal risk to life,it brings psychological and physical pain to the patient.According to the existing studies,antibiotics,hormones,anti tuberculosis drugs,immunosuppressants are all drugs that can be used to treat GLM.However,due to the lack of unified treatment guidelines and a large number of clinical studies,researchers still have a lot of controversy about the best treatment for GLM.Compared with drug therapy,surgery can relieve clinical symptoms faster and shorten the course of disease greatly.But at the same time,the operation is also faced with a series of problems,such as postoperative breast shape change,poor wound healing,scar hyperplasia,postoperative recurrence and so on.Traditional Chinese medicine has unique advantages in understanding and treating this disease.Although there is no GLM,most Chinese medicine scholars classify GLM as acne mastitis,and divide it into three stages:initial stage,abscess stage and ulceration stage.Tuoli toupu decoction is the representative prescription of Yiqi Jiedu and Tuoli toupu.It has good curative effect on carbuncle and abscess.However,the specific effect of its role needs to be further demonstrated by objective and quantitative data,and the specific mechanism of its role needs to be further explored.Our previous basic research has shown that Tuoli toupu decoction can effectively reduce the serum levels of inflammatory factors in patients with granulomatous lobular mastitis.Now from the clinical aspect,we will study the improvement of clinical symptoms and the influence of inflammatory factors in patients with GLM by Tuoli toupu decoction,so as to provide more objective basis for the clinical application of Tuoli toupu Decoction in the treatment of GLM;It can also provide a basis for further study on the relationship between these inflammatory factors and the pathogenesis of GLM.Objective:To explore the improvement of clinical symptoms and the protein expression of inflammatory factors TLR4,NF-?B,caspase1,IL-1? and IL-18 in the lesions of patients with GLM by oral administration of Tuoli toupu decoction combined with incision and drainage compared with simple incision and drainage.Methods:A randomized controlled trial was conducted to study female patients with granulomatous lobular mastitis in abscess stage diagnosed as Qi deficiency and phlegm coagulation in Dongzhimen Hospital of Beijing University of traditional Chinese medicine from February 2019 to January 2021.They were randomly divided into control group,simple incision and drainage group,and experimental group,oral administration of Tuoli toupu decoction combined with incision and drainage group.All patients were treated with abscess incision and drainage on the first day,and then the dressing was changed daily.At the same time,patients in the experimental group began to take one bag of tuolitoupu Decoction granules in the morning and evening.The treatment course of the two groups was set as 7 days.If the second stage operation treatment standard was reached during the treatment,or the wound and sinus were completely healed,the treatment time was counted,the treatment was stopped,and the curative effect index was counted.Results:A total of 74 subjects were included,including 30 cases in the control group and 44 cases in the experimental group.The total effective rate was 59.1%,which was significantly better than 33.3%in the simple incision and drainage group(P<0.05).There was no significant difference in the expression of TLR4,NF-?B,caspase1,IL-1? and IL-18 in the lesions between the two groups.Conclusion:1.Compared with simple incision and drainage,taking Tuoli toupu decoction can effectively improve the clinical symptoms of patients with GLM,especially in relieving pain,improving mood and alleviating the skin state of the lesions,the effect of the experimental group after treatment is significantly better than that of the control group;2.The effect of oral taking Tuoli toupu Decoction on the expression of inflammatory factors caspase1,IL-1?,IL-18,TLR4 and NF-?B in the lesions of patients with GLM still needs to be studied Further exploration.