Wang Pin, Sun Jia-Zheng, Fang Hui-Ying, Yang De-Juan, Ren Guo-Sheng
Department of General Surgery, the Third People's Hospital of Chengdu, Chengdu, People's Republic of China.
Center of Breast and Thyroid Surgery, the Third People's Hospital of Chengdu, Chengdu, People's Republic of China.
J Inflamm Res. 2024 Nov 25;17:9617-9624. doi: 10.2147/JIR.S498018. eCollection 2024.
Idiopathic granulomatous mastitis (IGM) is a chronic breast condition known for its aggressive nature and tendency for persistence and recurrence. Steroids are commonly used as the first-line treatment for IGM, but issues such as the optimal timing, and duration of treatment remain debated.
We retrospectively analyzed 343 IGM cases treated at the Third People's Hospital of Chengdu from September 2012 to September 2023. Based on inclusion and exclusion criteria, a total of 188 patients were included in the study. Patients were categorized into lump (78 cases), abscess (81 cases), and sinus tract stages (29 cases) according to their initial diagnosis upon admission. Prednisolone was initiated at 0.75 mg/kg/day, and after effective treatment, the dosage was adjusted by 5-10 mg weekly, followed by a maintenance dose of 2.5-5 mg/day. Clinical characteristics, treatment responses, adverse effects, recurrence rates, and follow-up data were assessed.
The median duration of prednisone treatment in our study was 87 days (range, 21-281 days). Positive response rates to prednisolone were 78.2% in the lump stage, 60.5% in the abscess stage, and 62.1% in the sinus tract stage. Continuing low-dose prednisone for 3 months post-effective treatment reduced recurrence rates and side effect risks. Weight gain was the most common side effect (39.36%).
Early steroid therapy, especially in the lump stage, demonstrated superior efficacy. Following a regimen of starting with a full dose, tapering slowly, and maintaining a low dose for around 3 months steroids treatment is recommended to minimize recurrence rate and adverse effects.
特发性肉芽肿性乳腺炎（IGM）是一种慢性乳腺疾病，以其侵袭性、持续性和复发性而闻名。类固醇通常被用作IGM的一线治疗药物，但治疗的最佳时机和持续时间等问题仍存在争议。
我们回顾性分析了2012年9月至2023年9月在成都市第三人民医院接受治疗的343例IGM病例。根据纳入和排除标准，共有188例患者纳入研究。患者根据入院时的初始诊断分为肿块期（78例）、脓肿期（81例）和窦道期（29例）。泼尼松龙起始剂量为0.75mg/kg/天，有效治疗后，剂量每周调整5-10mg，随后维持剂量为2.5-5mg/天。评估临床特征、治疗反应、不良反应、复发率和随访数据。
本研究中泼尼松治疗的中位持续时间为87天（范围21-281天）。泼尼松龙在肿块期的阳性反应率为78.2%，脓肿期为60.5%，窦道期为62.1%。有效治疗后持续低剂量泼尼松3个月可降低复发率和副作用风险。体重增加是最常见的副作用（39.36%）。
早期类固醇治疗，尤其是在肿块期，显示出更好的疗效。建议采用全剂量起始、缓慢减量并维持低剂量约3个月的治疗方案，以尽量降低复发率和不良反应。
