目的

探讨抗酸染色对非哺乳期乳腺炎的诊断价值。

方法

回顾性分析2014 年2 ～12 月在成都市妇女儿童中心医院经临床确诊的54 例非哺乳期乳腺炎患者的临床资料,并收集患者的乳腺组织标本,包括33 例导管周围乳腺炎(PDM)和21 例肉芽肿性乳腺炎(GM)。 对所有组织标本进行常规病理检查和抗酸染色,以便查找非结核性分支杆菌。 PDM 与GM 抗酸染色阳性率的比较采用χ² 检验。

结果

54 例非哺乳期乳腺炎患者的主要临床表现为乳房肿块、迁延不愈的脓肿、窦道以及乳房红肿。 镜下病理表现:在33 例PDM 组织标本中,28 例(84.8%)可见扩张导管,24 例(72.7%)可见脓肿形成,11 例(33.3%)可见大量中性粒细胞浸润,24 例(72.7%)可见大量浆细胞、淋巴细胞浸润,并有24 例抗酸染色阳性,阳性率约为72.7%;而在21 例GM 组织标本中,18 例(85.7%)可见肉芽肿结构,12 例(57.1%)可见微脓肿结构,全部GM 组织标本均可见中性粒细胞、淋巴细胞等炎细胞浸润,并有2 例抗酸染色阳性,阳性率约为9.5%。 PDM 患者抗酸染色阳性率明显高于GM 患者(χ²=20.534,P＜0.001)。

结论

抗酸染色可作为鉴别PDM 与GM 的一种手段,并可为临床上运用异烟肼、利福平、乙胺丁醇“三联”药物治疗PDM 提供病理依据,值得临床推广。

Objective

To explore the value of acid-fast stain test in the diagnosis of non-lactational mastitis.

Methods

We retrospectively analyzed the clinical data of 54 cases of non-lactational mastitis(including 33 cases of pathologically diagnosed periductal mastitis and 21 cases of granulomatous mastitis) in Chengdu Women and Children's Central Hospital from February to December in 2014. All histological specimens were pathologically detected and acid-fast stain was conducted to look for the acid-fast bacilli. The acid-fast stain positive rates were compared between periductal mastitis group and granulomatous mastitis group using Chi-square test.

Results

The main clinical manifestations in 54 cases of non-lactational mastitis included breast mass, protracted abscess, sinus and red swelling. Among 33 cases of periductal mastitis,there were 28(84.8%) patients with dilated ducts, 24 (72.7%) with abscess, 11 (33.3%) with numerous neutrophils infiltrating,24(72.7%) with numerous plasma cells and lymphocytes infiltrating and 24 (72.7%)positive in acid-fast stain. Among 21 cases of granulomatous mastitis, there were 18(85.7%) patients with granulomatous structure,12(57.1%) with microabscess,21(100%) with neutrophils, lymphocytes and other inflammatory cells infiltrating and 2 (9.5%) positive in acid-fast stain. For acid-fast stain test, the positive rate of periductal mastitis patients was significantly higher than that of granulomatous mastitis patients (χ² =20.534, P＜0.001).

Conclusion

The acid-fast stain test is helpful in the differential diagnosis of periductal mastitis and granulomatous mastitis, which can provide the pathological reference for using triple antimicrobial therapy (rifampin, isoniazid and ethambutol) in the treatment of periductal mastitis.