目的: 探究肉芽肿性乳腺炎（granulomatous mastitis,GLM）肿块期患者超声图像特征与临床病理分期及中医证型分布的关系。方法: 回顾性选取2022年8月—2023年8月本院收治的GLM肿块期患者56例,将其纳入肿块期组,另选取同时期本院收治的GLM非肿块期（脓肿期、溃后期）患者30例,将其纳入非肿块期组。所有患者均进行多普勒超声检查并经病理确诊。比较2组患者超声图像特征差异（病灶大小、形态、边界、回声、钙化、导管扩张、血流信号）,并应用多因素回归模型分析超声图像特征与GLM肿块期的关系。根据中医证候和舌脉象将患者分为肝郁痰凝证、肝胃郁热证、痰瘀互阻证、以及阳虚痰凝证4种证型,比较不同证型GLM肿块期患者超声图像特征差异。结果: 肿块期组患者病灶<6 cm、边界清晰、回声均匀、无钙化、无导管扩张、血流信号0~Ⅰ 级的比例明显高于非肿块期组,差异有统计学意义;多因素回归分析结果显示,无导管扩张、血流信号0~Ⅰ 级是GLM肿块期的独立危险因素;不同证型GLM肿块期患者超声图像血流信号组间比较,差异有统计学意义,其中阳虚痰凝证血流信号0~Ⅰ级的例数（6例,75.00%）最高,肝胃郁热证（2例,12.50%）最低。结论: 不同分期GLM患者超声图像病灶大小、边界、回声、钙化、导管扩张、血流信号等特征不同,超声图像显示无导管扩张、血流信号0~Ⅰ 级属于GLM肿块期的可能性更大;GLM肿块期不同中医证型下的超声血流信号存在一定差异,临床可利用超声血流信号进行GLM肿块期中医辨证分型的辅助诊断。

Objective To explore the relationship between ultrasound image characteristics and clinicopathological staging and TCM syndrome type distribution in patients with granulomatous mastitis (GLM) in mass stage. Methods 56 patients with GLM in mass stage in the hospital were retrospectively selected from August 2022 to August 2023 and included in mass stage group. In addition, 30 patients with GLM in non-mass stage (abscess stage, post-ulcer stage) during the same time period were selected and enrolled as non-mass stage group. All patients underwent Doppler ultrasonography and were confirmed by pathology. The differences in ultrasound image characteristics (lesion size, shape, boundary, echo, calcification, catheter dilatation, blood flow signal) between the two groups were compared, and the relationship between ultrasound image characteristics and GLM in mass stage was analyzed by multivariate regression model. According to TCM syndrome types and tongue pulse conditions, the patients were divided into four syndromes: liver depression and phlegm coagulation syndrome, liver-stomach stagnation heat syndrome, phlegm-blood stasis blocking syndrome and yang deficiency and phlegm coagulation syndrome. The differences in ultrasound image characteristics were compared among patients with GLM in mass stage of different syndrome types. Results The proportions of lesions <6 cm, clear boundary, uniform echo, no calcification, no catheter dilatation and blood flow signal grade 0-I in mass stage group were significantly higher than those in non-mass stage group. Multivariate regression analysis showed that no catheter dilatation and blood flow signal grade 0-I were independent risk factors for GLM in mass stage. There was a statistically significant difference in the blood flow signal of ultrasound image among patients with different syndrome types of GLM in mass stage. The number of cases with blood flow signal grade 0-I in yang deficiency and phlegm coagulation syndrome (6 cases, 75.00%) was the highest, and the liver-stomach stagnation syndrome (2 cases, 12.50%) was the lowest. Conclusion The ultrasound image characteristics of lesion size, boundary, echo, calcification, catheter dilatation and blood flow signal in patients with different stages of GLM are different. Ultrasound images show that no catheter dilatation and blood flow signal grade 0-I are more likely to belong to GLM in mass stage. There are some differences in ultrasound blood flow signals under different TCM syndrome types of GLM in mass stage. Ultrasound blood flow signal can be used to assist the diagnosis of TCM syndrome differentiation of GLM in mass stage.