切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 284 -291. doi: 10.3877/cma.j.issn.1674-0807.2022.05.004

论著

克氏棒状杆菌感染的肉芽肿性小叶性乳腺炎患者的血象特点分析
郑碧连1, 陈创1, 孙圣荣1,()   
  1. 1. 430060 武汉大学人民医院乳腺甲状腺外科
  • 收稿日期:2022-03-10 出版日期:2022-10-01
  • 通信作者: 孙圣荣

Hematological parameters in granulomatous lobular mastitis patients with Corynebacterium kroppenstedtii infection

Bilian Zheng1, Chuang Chen1, Shengrong Sun1,()   

  1. 1. Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
  • Received:2022-03-10 Published:2022-10-01
  • Corresponding author: Shengrong Sun
引用本文:

郑碧连, 陈创, 孙圣荣. 克氏棒状杆菌感染的肉芽肿性小叶性乳腺炎患者的血象特点分析[J/OL]. 中华乳腺病杂志(电子版), 2022, 16(05): 284-291.

Bilian Zheng, Chuang Chen, Shengrong Sun. Hematological parameters in granulomatous lobular mastitis patients with Corynebacterium kroppenstedtii infection[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(05): 284-291.

目的

分析肉芽肿性小叶性乳腺炎(GLM)患者的病原菌分布,探讨克氏棒状杆菌(克氏菌)感染与GLM患者外周血血象指标变化的关系。

方法

回顾性分析2017年10月至2021年6月武汉大学人民医院乳腺甲状腺中心诊治的81例GLM患者临床资料和纳米孔测序获得的病原菌检测结果。根据病原菌感染分为3组:克氏菌组(50例)、非克氏菌组(19例)和阴性组(12例),并将50例克氏菌组患者按病程阶段分为早期(21例)和晚期(29例)。计数资料以绝对数表示。采用Kruskal-Wallis H检验或Mann-Whitney U检验比较3组患者外周血白细胞计数和中性粒细胞与淋巴细胞比值(NLR)的差异,受试者工作特征曲线检验外周血白细胞计数和NLR对克氏菌感染的鉴别诊断价值,Kappa检验用于外周血白细胞计数和NLR与纳米孔测序的一致性检验。

结果

(1)85.2%(69/81)患者的样本中检测到病原菌,其中61.7%(50/81)患者存在克氏菌感染。(2)克氏菌组、非克氏菌组和阴性组患者的外周血白细胞计数异常率分别为48.0%(24/50)、3/19和4/12,组间比较差异有统计学意义(χ2=6.192,P=0.045),克氏菌组高于非克氏菌组(χ2=5.997,Bonferroni校正后P=0.043)。3组患者的外周血白细胞计数分别为9.09(7.50,12.02)×109个/L、7.58(6.47,8.20)×109个/L和7.62(6.99,9.84)×109个/L,组间比较差异有统计学意义(H=8.748,P=0.013),克氏菌组高于非克氏菌组(Z=-2.861,Bonferroni校正后P=0.012)。早期患者的外周血白细胞异常率和白细胞计数均低于晚期患者[28.6%(6/21)比62.1%(18/29),χ2=5.476,P=0.019;7.50(6.74,10.65)×109个/L比9.69(8.76,13.67)×109个/L,Z=3.155,P=0.002]。(3)3组患者的NLR分别为3.47(2.67,5.73)、2.95(2.04,3.35)和3.06(1.87,3.37),组间比较差异有统计学意义(H=9.417,P=0.009),克氏菌组NLR高于非克氏菌组(Z=-2.556,Bonferroni校正后P=0.039)。早期患者的NLR低于晚期患者[3.27(1.89,3.89)比4.45(3.13,6.86),Z=2.251,P=0.024]。(4)外周血白细胞计数的ROC曲线下面积为0.724(95%CI:0.599~0.849,P=0.004),Kappa系数为0.359,当外周血白细胞计数>8.33×109个/L时诊断克氏菌感染的敏感度、特异度、准确率、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数和假阴性率分别为54.0%(27/54)、18/19、55.6%(45/81)、96.4%(27/28)、43.9%(18/41)、10.260、0.507、0.487、46.0%(23/50)。NLR的ROC曲线下面积为0.701(95%CI:0.577~0.826,P=0.010),Kappa系数为0.313,当NLR>3.13时诊断克氏菌感染的敏感度、特异度、准确率、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数和假阴性率分别为68.0%(34/50)、13/19、58.0%(47/81)、85.0%(34/40)、44.8%(13/29)、2.153、0.467、0.364、32.0%(16/50)。

结论

克氏菌与GLM关系密切,伴有克氏菌感染的GLM患者外周血炎症指标更高。临床医师在GLM的诊疗过程中应该重视病原菌的检测,为患者提供更加个体化、精准化的治疗方案。

Objective

To investigate the prevalence of pathogenic bacteria in patients with granulomatous lobular mastitis (GLM) and explore the relationship between Corynebacterium kroppenstedtii (CK) infection and peripheral hematological parameters.

Methods

The clinical data and pathogenic bacteria identification by nanopore sequencing of 81 patients with GLM in the Renmin Hospital of Wuhan University from October 2017 to June 2021 were reviewed retrospectively. The enrolled patients were divided into 3 groups according to the pathogenic results: CK-positive group (n=50), CK-negative group (n=19) and non-pathogenic group (n=12). The CK-positive group was further divided into the early-stage subgroup (n=21) and the advanced-stage subgroup (n=29). Counting data is expressed in absolute numbers. The Kruskal-Wallis H test or Mann-Whitney U test was used to compare peripheral white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) among three groups. The receiver operating characteristic (ROC) curve were plotted to analyze the value of WBC count and NLR in detecting CK infection, and the Kappa test was used to analyze the consistency of WBC count and NLR with nanopore sequencing.

Results

Approximately 85.2% (69/81) of the patients were tested positive by nanopore sequencing, of which 61.7% (50/81) were CK-positive. The proportion of patients with abnormal WBC count in CK-positive group, CK-negative group and non-pathogenic group was 48.0% (24/50), 3/19 and 4/12, respectively, indicating a significant difference (χ2=6.192, P=0.045). The proportion of patients with abnormal WBC count in CK-positive group was significantly higher than that in CK-negative group (χ2=5.997, P=0.043 after Bonferroni correction). The peripheral WBC count in CK-positive group, CK-negative group and non-pathogenic group was 9.09 (7.50, 12.02)×109 cells/L, 7.58 (6.47, 8.20)×109 cells/L, and 7.62 (6.99, 9.84)×109 cells/L, respectively, indicating a significant difference (H=8.748, P=0.013). The peripheral WBC count in CK-positive group was significantly higher than that in CK-negative group (Z=-2.861, P=0.012 after Bonferroni correction). The proportion of patients with WBC abnormality and WBC count in early-stage subgroup were significantly lower than those in advanced-stage subgroup [28.6% (6/21) vs 62.1% (18/29), χ2=5.476, P=0.019; 7.50 (6.74, 10.65)× 109/L vs 9.69 (8.76, 13.67)×109/L, Z=3.155, P=0.002]. (3) The NLR in CK-positive group, CK-negative group and non-pathogenic group was 3.47 (2.67, 5.73), 2.95 (2.04, 3.35) and 3.06 (1.87, 3.37), respectively, suggesting a significant difference (H=9.417, P=0.009). The NLR in CK-positive group was significantly higher than that in CK-negative group (Z=-2.556, P=0.039 after Bonferroni correction). The NLR in early-stage subgroup were significantly lower than that in advanced-stage subgroup [3.27 (1.89, 3.89) vs 4.45 (3.13, 6.86), Z=2.251, P=0.024]. (4) The area under the ROC curve of WBC count was 0.724 (95%CI: 0.599-0.849, P=0.004), and the Kappa coefficient was 0.359. If WBC count > 8.33×109 cells/L, its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Youden index and false negative rate in diagnosing CK-infection were 54.0% (27/54), 94.7% (18/54), 55.6% (45/81), 96.4% (27/28), 43.9% (18/41), 10.260, 0.507, 0.487 and 46.0% (23/50), respectively. The area under the ROC curve of NLR was 0.701 (95%CI: 0.577-0.826, P=0.010), and the Kappa coefficient was 0.313. If NLR>3.13, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Youden index and false negative rate in diagnosing CK-infection were 68.0% (34/50), 68.4% (13/19), 58.0% (47/81), 85.0% ( 34/40), 44.8% (13/29), 2.153, 0.467, 0.364 and 32.0% (16/50), respectively.

Conclusions

CK is closely related to GLM, and GLM patients with CK infection show high level in hematological inflammation parameters. Clinicians should pay attention to pathogen detection in the diagnosis and treatment of GLM and provide individualized precise regimens.

图1 克氏棒状杆菌感染的肉芽肿性小叶性乳腺炎患者乳房外观 注:可见先天性乳头凹陷和乳晕周围红肿伴脓肿形成
图2 克氏棒状杆菌感染的肉芽肿性小叶性乳腺炎患者术后病理图(HE ×200) 注:以小叶为中心的非干酪样肉芽肿形成,伴炎性细胞浸润
表1 81例肉芽肿性小叶性乳腺炎患者临床病理特征[例(%)]
表2 81例肉芽肿性小叶性乳腺炎患者病原菌分布
表3 81例肉芽肿性小叶性乳腺炎3种细菌感染分组的基线资料比较
表4 81例肉芽肿性小叶性乳腺炎3种细菌感染分组的外周血白细胞计数比较
图3 肉芽肿性小叶性乳腺炎外周血白细胞计数和中性粒细胞与淋巴细胞比值的受试者工作特征曲线 注:外周血白细胞计数的受试者工作特征曲线下面积为0.724(95%CI:0.599~0.849,P=0.004);中性粒细胞与淋巴细胞比值的受试者工作特征曲线下面积为0.701(95%CI:0.577~0.826,P=0.010)
[1]
Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma[J]. Am J Clin Pathol, 1972, 58(6):642-646.
[2]
Pala EE, Ekmekci S, Kilic M, et al. Granulomatous mastitis: a clinical and diagnostic dilemma[J]. Turk Patoloji Derg, 2022, 38(1):40-45.
[3]
张超杰,胡金辉,赵希.肉芽肿性小叶性乳腺炎诊治湖南专家共识(2021版)[J]. 中国普通外科杂志2021, 30(11):1257-1273.
[4]
孙岩峰,王永,李玉胜,等.特发性肉芽肿性乳腺炎的诊疗进展[J/CD]. 中华乳腺病杂志(电子版), 2017, 11(6):372-374.
[5]
李昕倩,吴红丽,罗澜,等.肉芽肿性小叶性乳腺炎细菌学研究进展[J/CD]. 中华乳腺病杂志(电子版), 2020, 14(4):244-247.
[6]
Bi J, Li Z, Lin X, et al. Etiology of granulomatous lobular mastitis based on metagenomic next-generation sequencing[J]. Int J Infect Dis, 2021, 113:243-250.
[7]
Li XQ, Yuan JP, Fu AS, et al. New insights of corynebacterium kroppenstedtii in granulomatous lobular mastitis based on nanopore sequencing[J]. J Invest Surg, 2022, 35(3):639-646.
[8]
Johnstone KJ, Robson J, Cherian SG, et al. Cystic neutrophilic granulomatous mastitis associated with corynebacterium including Corynebacterium kroppenstedtii[J]. Pathology, 2017, 49(4):405-412.
[9]
Wang Y, Song J, Tu Y, et al. Minimally invasive comprehensive treatment for granulomatous lobular mastitis[J]. BMC Surg, 2020, 20(1):34.
[10]
李昕倩,陈创,孙圣荣.手术与非手术治疗肉芽肿性小叶性乳腺炎疗效及复发因素分析[J]. 临床外科杂志2022, 30(2):145-148.
[11]
Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation[J]. World J Surg, 2007, 31(8):1677-1681.
[12]
Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update[J]. J Clin Pathol, 2020, 73(8):445-453.
[13]
Tauch A, Fernández-Natal I, Soriano F. A microbiological and clinical review on Corynebacterium kroppenstedtii[J]. Int J Infect Dis, 2016, 48:33-39.
[14]
Saraiya N, Corpuz M. Corynebacterium kroppenstedtii: a challenging culprit in breast abscesses and granulomatous mastitis[J]. Curr Opin Obstet Gynecol, 2019, 31(5):325-332.
[15]
李宾,王冠,牛丙寅,等. 不同病原微生物重症感染患者炎症因子水平变化研究[J]. 河北医科大学学报2018, 39(9):1077-1081.
[16]
Corbeau I, Jacot W, Guiu S. Neutrophil to lymphocyte ratio as prognostic and predictive factor in breast cancer patients: a systematic review[J]. Cancers (Basel), 2020, 12(4):958.
[17]
Andras D, Crisan D, Craciun R, et al. Neutrophil-to-lymphocyte ratio: a hidden gem in predicting neoadjuvant treatment response in locally advanced rectal cancer?[J]. J BUON, 2020, 25(3):1436-1442.
[18]
Bowen RC, Little N, Harmer JR, et al. Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis[J]. Oncotarget, 2017, 8(19):32 171-32 189.
[19]
Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients[J]. Mod Rheumatol, 2016, 26(3):372-376.
[20]
Pan L, Du J, Li T, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio associated with disease activity in patients with Takayasu’s arteritis: a case-control study[J]. BMJ Open, 2017, 7(4):e014451.
[21]
李萌,姚莉,王菁,等. NLR PLR在评估重症肺炎患者预后中的价值[J]. 安徽医学2020, 41(4):463-466.
[22]
Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19[J]. Am J Hematol, 2020, 95(7):834-847.
[23]
Kargin S, Turan E, Esen HH, et al. Role of pre-treatment neutrophil-lymphocyte ratio in the prediction of recurrences after granulomatous mastitis treatment[J].Turk J Med Sci, 2020, 40(1):46-51.
[24]
Çetinkaya ÖA, Çelik SU, Terzioǧlu SG, et al. The predictive value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with recurrent idiopathic granulomatous mastitis[J]. Eur J Breast Health, 2020, 16(1):61-65.
[1] 农云洁, 黄小桂, 黄裕兰, 农恒荣. 超声在多重肺部感染诊断中的临床应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 872-876.
[2] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[3] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[4] 费翔, 马帅, 张颖, 高洋, 毕冬宁, 孙平东, 崔建春. 乳腺腺叶可视化技术在乳管内乳头状瘤手术中的应用[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 464-464.
[5] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[6] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[7] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[10] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[11] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[12] 王帅, 张志远, 苏雨晴, 李雯雯, 王守凯, 刘琦, 李文涛. 孟德尔随机化及其在乳腺癌研究中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 671-676.
[13] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[14] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要