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中华乳腺病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 161 -168. doi: 10.3877/cma.j.issn.1674-0807.2021.03.006

论著

不同方法治疗肉芽肿性小叶性乳腺炎有效性的网状Meta分析
王雨晨1, 达娃卓玛1, 夏耘1,†()   
  1. 1. 430000　武汉，华中科技大学同济医学院附属同济医院甲状腺乳腺外科
  • 收稿日期:2020-10-20 出版日期:2021-07-01
  • 通信作者: 夏耘

Efficacy of different methods for treatment of granulomatous lobular mastitis: a network meta-analysis

Yuchen Wang1, Zhuoma Dawa1, Yun Xia1,†()   

  1. 1. Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
  • Received:2020-10-20 Published:2021-07-01
  • Corresponding author: Yun Xia
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引用本文：

王雨晨, 达娃卓玛, 夏耘. 不同方法治疗肉芽肿性小叶性乳腺炎有效性的网状Meta分析[J]. 中华乳腺病杂志(电子版), 2021, 15(03): 161-168.

Yuchen Wang, Zhuoma Dawa, Yun Xia. Efficacy of different methods for treatment of granulomatous lobular mastitis: a network meta-analysis[J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(03): 161-168.

目的

评价不同方法治疗肉芽肿性小叶性乳腺炎的有效性。

方法

全面检索PubMed、Embase、Cochrane Library、中国知网、维普、万方数据库中公开发表的有关于肉芽肿性小叶性乳腺炎治疗的文献，检索时间均为自建库起至2020年6月30日。由2名研究者按照所制定的纳入及排除标准独立进行文献筛选并提取资料，使用Cochrane协作网提供的偏倚风险评估工具对纳入文献进行质量评价。采用Stata 16.0软件进行网状Meta分析，采用漏斗图、Begger秩相关检验及Egger线性回归分析文献的发表偏倚；将累积排序概率图下面积(SUCRA)和平均等级值作为评价指标，对各种治疗措施进行优劣排序。

结果

共纳入29篇文献，共计1 585例病理学明确诊断为肉芽肿性小叶性乳腺炎的患者，涉及7种治疗措施[糖皮质激素(简称激素)、手术、激素联合手术、抗生素、切开引流、激素联合甲氨蝶呤、观察]。共有3篇文献证据等级评为A级，其余文献证据等级均为B级。Begger秩相关检验及Egger线性回归法均提示无明显发表偏倚(P＝0.133、0.177)。网状Meta分析结果提示：使用激素联合手术治疗的有效率优于单纯手术治疗(RR＝1.14，95%CI：1.06～1.23)、单纯激素治疗(RR＝1.25，95%CI：1.11～1.40)和切开引流(RR＝0.70，95%CI：0.57～0.85)；激素治疗优于抗生素治疗(RR＝0.58，95%CI：0.34～0.98)；手术优于切开引流(RR＝0.80，95%CI：0.67～0.95)；激素联合甲氨蝶呤优于抗生素治疗(RR＝2.11，95%CI：1.14～3.88)，观察优于抗生素治疗(RR＝1.97，95%CI：1.15～3.36)。7种干预措施治疗肉芽肿性小叶性乳腺炎的有效率排序：激素联合手术(SUCRA＝89.5)>观察(SUCRA＝78.1)>激素联合甲氨蝶呤(SUCRA＝67.8)>手术(SUCRA＝59.0)>激素(SUCRA＝35.1)>切开引流(SUCRA＝18.4)>抗生素(SUCRA＝2.0)。

结论

在7种治疗方法中，激素联合手术治疗肉芽肿性小叶性乳腺炎效果最佳。

关键词: 肉芽肿性乳腺炎, 甾类, 外科手术, Meta分析
Objective

To evaluate the efficacy of different methods for treatment of granulomatous lobular mastitis by a network meta-analysis.

Methods

The PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases were searched for studies on the treatment of granulomatous lobular mastitis. The retrieval time was from the establishment of the database to June 30, 2020. According to the inclusion and exclusion criteria, two researchers independently screened and extracted data. The inclusion bias risk assessment tool provided by the Cochrane Collaboration was used to evaluate the included literature. Stata 16.0 software was used for a network meta-analysis. The funnel plot, Begger rank correlation test and Egger linear regression analysis were used to evaluate publication bias. Surface under the cumulative ranking area (SUCRA) and average grade value were used as evaluation parameters to rank the seven methods.

Results

A total of 29 articles were included, involving 1 585 patients with granulomatous lobular mastitis, seven methods (steroid therapy, surgery, steroid therapy combined with surgery, antibiotic therapy, incision and drainage, combined use of steroid and methotrexate, observation). Three studies were evaluatedas level A evidences and the others level B. No significant publication bias was observed in the Begger rank correlation test (P=0.133) and the Egger linear regression (P=0.177). The network meta-analysis suggested that according to the effective rate, steroid therapy combined with surgery was superior to surgery alone (RR=1.14, 95%CI: 1.06-1.23) or steroid therapy alone (RR=1.25, 95%CI: 1.11-1.40) or incision and drainage (RR=0.70, 95%CI: 0.57-0.85); steroid therapy was superior to antibiotic therapy (RR=0.58, 95%CI: 0.34-0.98); surgery was superior to incision and drainage (RR=0.80, 95%CI: 0.67-0.95); combined use of steroid and methotrexate was superior to antibiotic therapy (RR=2.11, 95%CI: 1.14-3.88); observation was superior to antibiotic therapy (RR=1.97, 95%CI: 1.15-3.36). The rank of seven methods was as follows based on SUCRA: steroid therapy combined with surgery (SUCRA=89.5)>observation (SUCRA=78.1)> combined use of steroid and methotrexate (SUCRA=67.8)>surgery (SUCRA=59.0)>steroid therapy (SUCRA=35.1)>incision and drainage (SUCRA=18.4)>antibiotic therapy (SUCRA=2.0).

Conclusion

Among the seven methods, steroid therapy combined with surgery is optimal for granulomatous lobular mastitis

Key words: Granulomatous mastitis, Steroids, Surgical procedures, operative, Meta-analysis
表1 纳入文献基本信息
研究者 年份 例数 治疗措施 治疗后有效率a 随访时间(月) 证据等级
Akahane等[8] 2013 24 手术1例，抗生素治疗11例，切开引流2例 手术100%，抗生素0/11,切开引流0/2 29(19～77) B
Akcan等[9] 2006 74 激素+手术21例，手术53例 激素+手术100%，手术53% 41(3～170) B
Altintoprak等[10] 2015 52 激素治疗28例，手术14例，抗生素10例 激素治疗89%，手术11/14 37.2(12～72) B
Bouton等[11] 2015 32 手术5例，观察27例 手术2/5，观察100% 7.4(0～20) B
Chirappapha等[12] 2018 36 激素治疗6例，手术23例，切开引流7例 手术65%，激素治疗5/6，切开引流4/7 20.7(1～118) B
Haddad等[13] 2020 10 激素治疗2例，激素+甲氨蝶呤6例，观察2例 3组均为完全缓解 16.5(10～25) B
Hovanessian Larsen等[14] 2009 54 激素治疗13例，抗生素38例，观察3例 激素治疗10/13，抗生素5%，观察3/3 NA(3～27) B
Hur等[15] 2013 50 激素治疗13例，手术12例，抗生素3例，切开引流14例，观察8例 手术11/12，激素治疗4/13，切开引流4/14，观察7/8，抗生素1/3 NA B
Karanlik等[16] 2014 60 激素治疗23例，激素+手术37例 激素治疗69%，激素+手术100% 38 (22～78) B
Kiyak等[17] 2014 24 手术15例，切开引流9例 手术15/15，切开引流8/9 34.8(10～66) B
Korkut等[18] 2015 73 手术36例，切开引流37例 手术89%，切开引流75% NA(25～46) B
Lai等[19] 2005 9 手术1例，观察8例 手术1/1，观察4/8 18.7(NA) B
Mahlab-Gur等[20] 2015 8 激素治疗1例，手术1例，抗生素2例，观察4例 观察组3/4，其余3组均完全缓解 NA B
Oran等[21] 2013 46 激素治疗25例，激素+手术3例，手术18例 激素治疗80%，激素+手术3/3，手术15/18 35.4(3～135) B
Pandey等[22] 2014 49 激素治疗44例，手术2例，观察3例 激素治疗79%，手术、观察均完全缓解 NA(6～11) B
Sakurai等[23] 2011 8 激素治疗7例，手术1例 2组均完全缓解 40.3 (14～67) B
Sheybani等[24] 2015 27 激素治疗15例，激素+甲氨蝶呤12例 激素治疗10/15，激素+甲氨蝶呤10/12 12.4(6～22) B
Shin等[25] 2017 20 手术18例，抗生素2例 手术9/18，抗生素0/2 45.5(22～98) B
Skandarajah等[26] 2015 8 激素治疗1例，手术2例，观察5例 3组均完全缓解 6(3～180) B
Yabanoglu等[27] 2015 77 激素治疗44例，手术33例 激素治疗79%，手术100% 16(2～34) B
陈璐[28] 2020 110 激素+手术55例，手术55例 激素+手术96%，手术85% NA B
陈兴等[29] 2016 20 激素治疗5例，手术10例，切开引流5例 激素治疗4/5，手术10/10，切开引流3/5 NA(18～24) B
崔仁忠等[30] 2015 100 激素治疗50例，手术50例 激素治疗84%，手术86% NA A
韩思佳等[31] 2018 46 激素+手术25例，手术21例 激素+手术92%，手术81% NA B
纪太芳等[32] 2018 90 激素+手术41例，手术49例 激素+手术27%，手术16% NA B
任佳等[33] 2019 200 激素+手术100例，手术100例 激素+手术94%，手术76% NA(6～12) A
谭艳芳[34] 2016 130 激素+手术65例，手术65例 激素+手术84%，手术86% NA A
杨帆[35] 2019 62 激素治疗18例，激素+手术44例 激素治疗7/18，激素+手术79% NA B
赵帅等[36] 2018 86 激素+手术42例，手术44例 激素+手术95%，手术77% NA B
图1 文献筛选流程图
图2 不同方法治疗肉芽肿性小叶性乳腺炎有效率比较的网状证据图
图3 运用漏斗图评估所有纳入文献的发表偏倚
图4 运用Egger线性回归法评估所有纳入文献的发表偏倚
图5 运用Begger秩相关检验评估所有纳入文献的发表偏倚
图6 不同方法治疗肉芽肿性小叶性乳腺炎有效率的不一致性检验图
图7 不同方法治疗肉芽肿性小叶性乳腺炎有效率的网状Meta分析结果
表2 不同方法治疗肉芽肿性小叶性乳腺炎有效率的SUCRA和平均等级值
治疗措施 SUCRA 平均等级值
糖皮质激素 35.1 4.9
手术 59.0 3.5
糖皮质激素联合手术 89.5 1.6
抗生素 2.0 6.9
切开引流 18.4 5.9
糖皮质激素联合甲氨蝶呤 67.8 2.9
观察 78.1 2.9
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