探讨改进肉芽肿性乳腺炎脓液标本棒状杆菌检测的方法。

依据纳入、排除标准，选取2016年6月至2017年2月广东省妇幼保健院乳腺病中心收治的37例肉芽肿性乳腺炎患者的37份脓液标本进行前瞻性研究。采用普通血平板和高脂血平板进行细菌培养，并用PCR检测脓液细菌，分析不同检测方法之间棒状杆菌阳性率的差异及检测结果的一致性。率的比较采用配对χ²检验(McNemar)及Kappa一致性检验。

在37份同时进行高脂血平板培养和PCR检测的脓液标本中，高脂血平板培养棒状杆菌阳性率为35.1%(13/37)，PCR检测棒状杆菌阳性率为48.6%(18/37)，2种方法比较，差异无统计学意义(P＝0.063)，并且2种方法检测结果的一致性较好(Kappa＝0.728，P<0.001)。在24份同时进行普通血平板、高脂血平板和PCR检测的脓液标本中，高脂血平板培养棒状杆菌阳性率为50.0%(12/24)，明显高于普通血平板的16.7%(4/24)(P＝0.008)；而高脂血平板培养棒状杆菌的阳性率与PCR检测的66.6%(16/24)比较，差异无统计学意义(P＝0.125)，并且2种方法的检测结果一致较好(Kappa＝0.667，P＝0.001)；普通血平板与PCR检测之间诊断水平的差异有统计学意义(P<0.001)。

高脂血平板更易培养出棒状杆菌，且高脂血平板制作简单，是值得临床推广的新型亲脂棒状杆菌培养方法。

To explore the detection method of corynebacteria in pus samples from granulomatous mastitis patients.

The 37 pus samples from 37 patients who were diagnosed with granulomatous mastitis in the Breast Disease Center, Guangdong Women and Children’s Hospital from June 2016 to February 2017 were prospectively analyzed. The common blood plate and high-fat blood plate were used for bacterial culture and PCR to detect the bacteria in pus. The positive rate of corynebacteria and the consistency of different detection methods were analyzed. Rates were compared using the paired χ² test (McNemar) and the Kappa consistency test.

In 37 pus samples that were simultaneously subjected to high-fat blood plate culture and PCR, the positive rate of corynebacteria was 35.1% (13/37) in high-fat blood plate culture, and 48.6% (18/37) in PCR, indicating no significant difference (P=0.063). The two methods presented a high consistency (Kappa =0.728, P<0.001). In 24 pus samples that were simultaneously subjected to common blood plate culture, high-fat blood plate culture and PCR, the positive rate of corynebacteria in high-fat blood plate culture was 50.0% (12/24), significantly higher than 16.7% (4/24) in common blood plate culture (P=0.008). The positive rate of corynebacteria was 66.6% (16/24) in PCR, indicating no significant difference compared with the rate in high-fat blood plate culture (P=0.125). The two methods presented a high consistency (Kappa =0.667, P=0.001). The diagnostic competence between common blood plate culture and PCR was significantly different (P<0.001).

It is easier to culture corynebacteria in high-fat blood plate, which can be easily prepared. This new culture method is worthy of clinical application.