摘要
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。
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 ba
作者
王雨晨
达娃卓玛
夏耘
Wang Yuchen;Dawa Zhuoma;Xia Yun(Department of Thyroid and Breast Surgery,Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)
出处
《中华乳腺病杂志（电子版）》
CAS
CSCD
2021年第3期161-168,共8页
Chinese Journal of Breast Disease(Electronic Edition)
关键词
肉芽肿性乳腺炎
甾类
外科手术
META分析
Granulomatous mastitis
Steroids
Surgical procedures,operative
Meta-analysis
