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Article(id=1240413931106259849, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412116, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733760000000, receivedDateStr=2024-12-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667326952, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667326952, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667326952, creator=13701087609, updateTime=1773667326952, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2725, endPage=2730, ext={EN=ArticleExt(id=1240413932851090342, articleId=1240413931106259849, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Influencing factors of mastitis in lactating mothers based on nested case-control study design, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the current situation and influencing factors of lactation mastitis in postpartum females, and to provide useful evidence for the prevention and control of lactation mastitis.

Methods

From January to October 2024, a cohort of pregnant females at 32-42 weeks of gestation was established in a tertiary hospital in Karamay city, and followed up until 42 days postpartum. Among them, 196 females who developed lactation mastitis were selected as the case group, and 196 females who did not develop lactation mastitis were matched 1:1 according to age ± 2 years as the control group. A self-designed questionnaire was used to investigate the basic information of the females. χ2 test and binary logistic regression analysis were used to analyze the influencing factors.

Results

A total of 624 pregnant females were included in this study.During the study period, 196 cases of lactation mastitis occurred, with an incidence rate of 31.41%. Binary logistic regression analysis showed that primiparity (OR=2.086, 95% CI: 1.316-3.307), nipple fissure (OR=3.593, 95% CI: 2.261-5.711),excessive milk production (OR=2.697, 95% CI: 1.393-2.261), family dysfunction (OR=2.435, 95% CI: 1.264-4.691), and co-occurrence of postpartum depression and anxiety (CAD) (OR=2.551, 95% CI: 1.369-4.755) were risk factors for lactation mastitis in postpartum females.

Conclusion

Hospitals and communities should fully play their supportive roles, provide personalized and systematic breastfeeding consultation and guidance for postpartum females and their family members, and emphasize the importance of family support to reduce the occurrence of lactation mastitis in postpartum females and promote breastfeeding.

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目的

了解产妇哺乳期乳腺炎（lactation mastitis，LM）的发生现状和影响因素，为LM的预防控制提供有益的依据。

方法

于2024年1—10月，在克拉玛依市某三甲医院建立孕32～42周孕妇队列，并随访至产后42 d。将队列中发生LM的196例产妇作为病例组，按照年龄±2岁1∶1匹配未发生LM的196例产妇作为对照组，通过自行设计的问卷调查产妇的基本情况。采用χ2检验和二元logistic回归分析影响因素。

结果

本研究共纳入624例孕妇，研究期间196例发生LM，LM发生率为31.41%。二元logistic回归分析结果显示产次为初产(OR=2.086，95%CI: 1.316～3.307)、乳头发生皲裂(OR=3.593，95%CI: 2.261～5.711)、泌乳量多(OR=2.697，95%CI: 1.393～2.261)、家庭功能障碍(OR=2.435，95%CI:1.264～4.691)、产后抑郁焦虑共患检出(OR=2.551，95%CI: 1.369～4.755)是产妇发生LM的危险因素。

结论

医院和社区应充分发挥支持作用，为哺乳期产妇及家庭成员提供个性化、系统化的母乳喂养咨询指导，强调家庭支持的重要性，以减少产妇LM的发生，促进母乳喂养。

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徐培兰，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=ZvUq08ZJNueemKw3XGJClw==, magXml=JSAeHAH2PQPn1dapmgV5Pg==, pdfUrl=null, pdf=6ZBbnqa3MWSrhpe3AxPXwg==, pdfFileSize=635890, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=+jPQ9o7/qErPfD8kXQMudQ==, mapNumber=null, authorCompany=null, fund=null, authors=

何静汶（1999—），女，硕士在读，研究方向：公共卫生

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何静汶（1999—），女，硕士在读，研究方向：公共卫生

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何静汶（1999—），女，硕士在读，研究方向：公共卫生

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Comprehensive evaluation of the risk of lactational mastitis in Chinese women: Combined logistic regression analysis with receiver operating characteristic curve[J].Bioscience Reports, 2020, 40(3): BSR20190919., articleTitle=Comprehensive evaluation of the risk of lactational mastitis in Chinese women: Combined logistic regression analysis with receiver operating characteristic curve, refAbstract=null)], funds=[Fund(id=1240424353779741358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, awardId=XJEDU2022P150, language=CN, fundingSource=自治区高校基本科研业务费科研项目(XJEDU2022P150), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424348071293292, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, xref=1., ext=[AuthorCompanyExt(id=1240424348079681902, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, companyId=1240424348071293292, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830017, China), AuthorCompanyExt(id=1240424348092264817, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, companyId=1240424348071293292, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.新疆医科大学公共卫生学院，新疆 乌鲁木齐 830017)]), AuthorCompany(id=1240424348184539513, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, xref=2., ext=[AuthorCompanyExt(id=1240424348188733817, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, companyId=1240424348184539513, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.新疆第二医学院公共卫生学院，新疆 克拉玛依 834000)])], figs=[ArticleFig(id=1240424352634696281, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=EN, label=Table 1, caption=

Univariate analysis of different characteristics of mastitis and control groups ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计乳腺炎组(n=196)对照组(n=196)χ2值P值
文化程度0.0400.998
初中及以下2713(6.6)14(7.1)
高中/中专4020(10.2)20(10.2)
本科/大专307154(78.6)153(78.1)
研究生及以上189(4.6)9(4.6)
产次8.8320.003
初产229129(65.8)100(51.0)
经产16367(34.2)96(49.0)
职业1.4580.482
固定职业285138(70.4)147(75.0)
个体经营3819(9.7)19(9.7)
家庭主妇6939(19.9)30(15.3)
家庭月收入(元)5.3400.149
≤5 0003823(11.7)15(7.7)
5 001～10 000226116(59.2)110(56.1)
10 001～15 0009847(24)51(26.0)
>15 0003010(5.1)20(10.2)
分娩方式0.3670.544
顺产194100(51.0)94(48.0)
剖宫产19896(49.0)102(52.0)
妊娠高血压0.1360.712
有3215(7.7)17(8.7)
无260181(92.3)179(91.3)
妊娠糖尿病0.7920.374
有7742(21.4)35(17.9)
无315154(78.6)161(82.1)
乳头皲裂45.511<0.001
是151108(55.1)43(21.9)
否24188(44.9)153(78.1)
泌乳量8.0690.018
少12049(25.0)71(36.2)
中19097(49.5)93(47.4)
多8250(25.5)32(16.3)
哺乳体位2.6000.107
卧位263139(70.9)124(63.3)
坐位16957(29.1)72(36.7)
乳盾使用情况(次/d)4.6040.100
未使用327157(80.1)170(86.7)
1～34726(13.3)21(10.7)
>31813(6.6)5(2.6)
婴儿含接姿势6.3790.041
含接不到乳头2517(8.7)8(4.1)
只含到乳头部分6739(19.9)28(14.3)
含到乳头和乳晕部分300140(71.4)160(81.6)
婴儿入睡方式1.8140.404
基本奶睡5927(13.8)32(16.3)
部分奶睡16991(46.4)78(39.8)
不奶睡16478(39.8)86(43.9)
家庭功能6.8270.009
障碍6341(20.9)22(11.2)
良好329155(79.1)174(88.8)
CAD检出情况13.9090.003
正常268151(77.0)117(59.7)
仅孕期CAD227(3.6)15(7.7)
仅产后CAD6624(12.2)42(21.4)
持续CAD3614(7.1)22(11.2)
), ArticleFig(id=1240424352747942495, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=CN, label=表1, caption=

乳腺炎组和对照组的不同特征的单因素分析［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计乳腺炎组(n=196)对照组(n=196)χ2值P值
文化程度0.0400.998
初中及以下2713(6.6)14(7.1)
高中/中专4020(10.2)20(10.2)
本科/大专307154(78.6)153(78.1)
研究生及以上189(4.6)9(4.6)
产次8.8320.003
初产229129(65.8)100(51.0)
经产16367(34.2)96(49.0)
职业1.4580.482
固定职业285138(70.4)147(75.0)
个体经营3819(9.7)19(9.7)
家庭主妇6939(19.9)30(15.3)
家庭月收入(元)5.3400.149
≤5 0003823(11.7)15(7.7)
5 001～10 000226116(59.2)110(56.1)
10 001～15 0009847(24)51(26.0)
>15 0003010(5.1)20(10.2)
分娩方式0.3670.544
顺产194100(51.0)94(48.0)
剖宫产19896(49.0)102(52.0)
妊娠高血压0.1360.712
有3215(7.7)17(8.7)
无260181(92.3)179(91.3)
妊娠糖尿病0.7920.374
有7742(21.4)35(17.9)
无315154(78.6)161(82.1)
乳头皲裂45.511<0.001
是151108(55.1)43(21.9)
否24188(44.9)153(78.1)
泌乳量8.0690.018
少12049(25.0)71(36.2)
中19097(49.5)93(47.4)
多8250(25.5)32(16.3)
哺乳体位2.6000.107
卧位263139(70.9)124(63.3)
坐位16957(29.1)72(36.7)
乳盾使用情况(次/d)4.6040.100
未使用327157(80.1)170(86.7)
1～34726(13.3)21(10.7)
>31813(6.6)5(2.6)
婴儿含接姿势6.3790.041
含接不到乳头2517(8.7)8(4.1)
只含到乳头部分6739(19.9)28(14.3)
含到乳头和乳晕部分300140(71.4)160(81.6)
婴儿入睡方式1.8140.404
基本奶睡5927(13.8)32(16.3)
部分奶睡16991(46.4)78(39.8)
不奶睡16478(39.8)86(43.9)
家庭功能6.8270.009
障碍6341(20.9)22(11.2)
良好329155(79.1)174(88.8)
CAD检出情况13.9090.003
正常268151(77.0)117(59.7)
仅孕期CAD227(3.6)15(7.7)
仅产后CAD6624(12.2)42(21.4)
持续CAD3614(7.1)22(11.2)
), ArticleFig(id=1240424352873771625, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=EN, label=Table 2, caption=

Variable assignment description table

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
产次经产=1，初产=2
乳头皲裂否=1，是=2
泌乳量少=1，中=2，多=3
婴儿含接姿势可含接到乳头和乳晕=1，含接不到乳头部分=2，只含接到乳头部分=3
家庭功能良好=1，障碍=2
CAD检出情况正常=1，仅孕期CAD=2，仅产后CAD=3，持续CAD=4
), ArticleFig(id=1240424353003795061, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=CN, label=表2, caption=

变量赋值说明表

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
产次经产=1，初产=2
乳头皲裂否=1，是=2
泌乳量少=1，中=2，多=3
婴儿含接姿势可含接到乳头和乳晕=1，含接不到乳头部分=2，只含接到乳头部分=3
家庭功能良好=1，障碍=2
CAD检出情况正常=1，仅孕期CAD=2，仅产后CAD=3，持续CAD=4
), ArticleFig(id=1240424353121235584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=EN, label=Table 3, caption=

Binary conditional logistic regression analysis of lactation mastitis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B值WaldOR(95%CI)P值
产次
初产（ref：经产）0.7350.2359.7752.086(1.316 ～3.307)0.002
乳头皲裂
是（ref：否）1.2790.23629.2633.593(2.261～5.711)<0.001
泌乳量
中（ref：少）0.6110.2665.2761.841(1.094～3.100)0.022
多（ref：少）0.9920.3378.6562.697(1.393～2.261)0.033
婴儿含接姿势
含接不到乳头部分（ref：可含接到乳头和乳晕）0.8660.4953.0622.377(0.901～6.269)0.080
只含接乳头部分（ref：可含接到乳头和乳晕）0.4000.3001.7801.492(0.829～2.687)0.182
家庭功能
障碍（ref：良好）0.8900.3347.0802.435(1.264～4.691)0.008
CAD检出情况
仅孕期CAD(ref：正常)0.4630.5270.7711.588 (0.566～4.458)0.380
仅产后CAD(ref：正常)0.9360.3188.6892.551(1.369～4.755)0.003
持续CAD(ref：正常)0.4900.4191.3681.632(0.718～3.708)0.242
), ArticleFig(id=1240424353268036231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=CN, label=表3, caption=

LM的二元条件logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B值WaldOR(95%CI)P值
产次
初产（ref：经产）0.7350.2359.7752.086(1.316 ～3.307)0.002
乳头皲裂
是（ref：否）1.2790.23629.2633.593(2.261～5.711)<0.001
泌乳量
中（ref：少）0.6110.2665.2761.841(1.094～3.100)0.022
多（ref：少）0.9920.3378.6562.697(1.393～2.261)0.033
婴儿含接姿势
含接不到乳头部分（ref：可含接到乳头和乳晕）0.8660.4953.0622.377(0.901～6.269)0.080
只含接乳头部分（ref：可含接到乳头和乳晕）0.4000.3001.7801.492(0.829～2.687)0.182
家庭功能
障碍（ref：良好）0.8900.3347.0802.435(1.264～4.691)0.008
CAD检出情况
仅孕期CAD(ref：正常)0.4630.5270.7711.588 (0.566～4.458)0.380
仅产后CAD(ref：正常)0.9360.3188.6892.551(1.369～4.755)0.003
持续CAD(ref：正常)0.4900.4191.3681.632(0.718～3.708)0.242
), ArticleFig(id=1240424353448391316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=EN, label=Table 4, caption=

Prevalence of depression and anxiety in late pregnancy and postpartum in females with lactation mastitis ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
孕晚期CAD产后CAD总计χ2值P值
是否
是22(59.5)15(41.5)3714.904<0.001
否42(26.4)117(73.6)159
总
计		64(32.7)132(67.3)196
), ArticleFig(id=1240424353557443231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413931106259849, language=CN, label=表4, caption=

LM产妇孕晚期和产后CAD检出情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
孕晚期CAD产后CAD总计χ2值P值
是否
是22(59.5)15(41.5)3714.904<0.001
否42(26.4)117(73.6)159
总
计		64(32.7)132(67.3)196
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基于巢式病例对照研究设计的产妇哺乳期乳腺炎影响因素分析
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何静汶 1 , 张晓慧 1 , 窦岚 2 , 徐培兰 2
现代预防医学 | 流行病与统计方法 2025,52(15): 2725-2730
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现代预防医学 | 流行病与统计方法 2025, 52(15): 2725-2730
基于巢式病例对照研究设计的产妇哺乳期乳腺炎影响因素分析
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何静汶1, 张晓慧1, 窦岚2, 徐培兰2
作者信息
  • 1.新疆医科大学公共卫生学院，新疆 乌鲁木齐 830017
  • 2.新疆第二医学院公共卫生学院，新疆 克拉玛依 834000

    • 何静汶（1999—），女，硕士在读，研究方向：公共卫生

通讯作者:

徐培兰，E-mail:
Influencing factors of mastitis in lactating mothers based on nested case-control study design
Jing-wen HE1, Xiao-hui ZHANG1, Lan DOU2, Pei-lan XU2
Affiliations
  • School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830017, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202412116
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摘要
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目的

了解产妇哺乳期乳腺炎（lactation mastitis，LM）的发生现状和影响因素，为LM的预防控制提供有益的依据。

方法

于2024年1—10月，在克拉玛依市某三甲医院建立孕32～42周孕妇队列，并随访至产后42 d。将队列中发生LM的196例产妇作为病例组，按照年龄±2岁1∶1匹配未发生LM的196例产妇作为对照组，通过自行设计的问卷调查产妇的基本情况。采用χ2检验和二元logistic回归分析影响因素。

结果

本研究共纳入624例孕妇，研究期间196例发生LM，LM发生率为31.41%。二元logistic回归分析结果显示产次为初产(OR=2.086，95%CI: 1.316～3.307)、乳头发生皲裂(OR=3.593，95%CI: 2.261～5.711)、泌乳量多(OR=2.697，95%CI: 1.393～2.261)、家庭功能障碍(OR=2.435，95%CI:1.264～4.691)、产后抑郁焦虑共患检出(OR=2.551，95%CI: 1.369～4.755)是产妇发生LM的危险因素。

结论

医院和社区应充分发挥支持作用，为哺乳期产妇及家庭成员提供个性化、系统化的母乳喂养咨询指导，强调家庭支持的重要性，以减少产妇LM的发生，促进母乳喂养。

哺乳期乳腺炎  /  巢氏病例对照研究  /  影响因素  /  抑郁焦虑共患
Objective

To understand the current situation and influencing factors of lactation mastitis in postpartum females, and to provide useful evidence for the prevention and control of lactation mastitis.

Methods

From January to October 2024, a cohort of pregnant females at 32-42 weeks of gestation was established in a tertiary hospital in Karamay city, and followed up until 42 days postpartum. Among them, 196 females who developed lactation mastitis were selected as the case group, and 196 females who did not develop lactation mastitis were matched 1:1 according to age ± 2 years as the control group. A self-designed questionnaire was used to investigate the basic information of the females. χ2 test and binary logistic regression analysis were used to analyze the influencing factors.

Results

A total of 624 pregnant females were included in this study.During the study period, 196 cases of lactation mastitis occurred, with an incidence rate of 31.41%. Binary logistic regression analysis showed that primiparity (OR=2.086, 95% CI: 1.316-3.307), nipple fissure (OR=3.593, 95% CI: 2.261-5.711),excessive milk production (OR=2.697, 95% CI: 1.393-2.261), family dysfunction (OR=2.435, 95% CI: 1.264-4.691), and co-occurrence of postpartum depression and anxiety (CAD) (OR=2.551, 95% CI: 1.369-4.755) were risk factors for lactation mastitis in postpartum females.

Conclusion

Hospitals and communities should fully play their supportive roles, provide personalized and systematic breastfeeding consultation and guidance for postpartum females and their family members, and emphasize the importance of family support to reduce the occurrence of lactation mastitis in postpartum females and promote breastfeeding.

Lactation mastitis  /  Nested case-control study  /  Influencing factors  /  Comorbid anxiety and depression
何静汶, 张晓慧, 窦岚, 徐培兰. 基于巢式病例对照研究设计的产妇哺乳期乳腺炎影响因素分析. 现代预防医学, 2025 , 52 (15) : 2725 -2730 . DOI: 10.20043/j.cnki.MPM.202412116
Jing-wen HE, Xiao-hui ZHANG, Lan DOU, Pei-lan XU. Influencing factors of mastitis in lactating mothers based on nested case-control study design[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2725 -2730 . DOI: 10.20043/j.cnki.MPM.202412116
正文
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哺乳期乳腺炎（lactation mastitis，LM）是在各种原因造成的乳汁淤积基础上，引发的乳腺炎症反应，是哺乳期妇女最常见的并发症之一[1]。多项研究指出，LM起病急骤、进展快速且反复发作，给产妇身心带来极大的痛苦，是导致产妇中断母乳喂养的主要原因[2-3]。若产妇发生LM后未引起足够重视，及早进行科学干预，甚至会进一步进展为乳腺脓肿，加剧产妇的痛苦和创伤[4]。厘清产妇LM发生的影响因素并采取相应的预防措施对于促进母乳喂养、维护母婴健康具有重要意义。既往LM的影响因素研究中，研究对象多为医院就诊的LM患者，调查时间多在产后，较少从孕期开始多维度关注LM发生的影响因素[5]。当前，LM影响因素研究越来越重视围产期妇女心理健康问题对LM产生的负向影响，与单一存在抑郁或者焦虑情绪相比，抑郁焦虑共患（comorbid anxiety and depression，CAD）对产妇的影响更大，因此使用专业量表评估孕产妇的抑郁焦虑情绪并探究其与LM发生之间的关联，具有一定研究意义[6-8]。综上所述，本研究通过巢式病例对照研究设计，观察产妇LM发生情况，多维度探讨LM发生的影响因素，为制订LM防治措施提供科学依据。
1　对象与方法
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1.1　研究对象
本研究采用巢氏病例对照研究设计，在克拉玛依市中心医院产科建立孕32～42周孕妇动态队列，随访至产后42 d。将队列中发生LM的产妇作为病例组，按照年龄±2岁1∶1随机匹配未发生LM的产妇作为对照组。研究对象纳入标准：（1）母乳喂养或混合喂养；（2）婴儿足月分娩且无先天性疾病；（3）能独立填写问卷。排除标准：（1）人工喂养；（2）婴儿出生体重<2 500 g或患有先天性及遗传性疾病；（3）患有乙肝、肺结核等急慢性传染病，重症心、肾疾病；（4）问卷填写不完整。本研究通过克拉玛依市中心医院伦理委员会批准后正式开展（批号：YL-2024-96）。
样本量计算：根据巢式病例对照研究样本量计算公式，其中：p0和p1分别为对照组和乳腺炎组乳头皲裂发生率，分别为0.45[9]和0.64[10]，α=0.05，β=0.1，P=（p0+p1）/2。通过计算得到乳腺炎组和对照组的样本量均至少需要142例。
1.2　研究方法
1.2.1　调查内容
根据国内外相关文献以及临床实践自行设计LM影响因素调查问卷，调查内容包括产妇的社会人口学特征、分娩情况、健康状况、哺乳相关行为、抑郁焦虑情绪以及家庭功能等。
其中，孕产妇的抑郁症状使用爱丁堡产后抑郁量表(edinburgh postnatal depression scale, EPDS)测量，产妇分别在进入队列时和产后42 d填写EPDS评估抑郁情况。该量表是由Cox等[11]于1987年编制的用于产妇自评产后抑郁发生情况的量表，在产前和产后抑郁的筛查中具有较高的信效度。本研究以EPDS>9.5分作为抑郁症状检出的临界值[12]。
孕产妇的焦虑症状采用中文版广泛焦虑量表(generalized anxiety disorder-7，GAD-7)测量，产妇分别在进入队列时和产后42 d填写GAD-7评估焦虑情况。该量表是由Spitzer等[13]于2006年编制的用于自评过去两周焦虑症状发生情况，在孕妇产前和产后的焦虑筛查中具有较高的信效度。本研究以GAD-7≥5分作为孕妇焦虑症状检出的临界值[14]。
采用家庭关怀度指数问卷(adaptation partnershi growth affection and resolve, APGAR)测量孕妇的家庭功能情况。该问卷由Smilkstein等[15]于1978年编制而成，于1995年由吕繁教授引入我国，在我国人群家庭功能测量中具有良好的信效度[16]。家庭功能等级划分标准如下：家庭功能得分0～3分代表家庭功能严重障碍，4～6分代表家庭功能中度障碍，7～10分代表家庭功能良好。本研究中由于家庭功能严重障碍组人数较少，故将家庭功能得分为0～6分的划分为家庭功能障碍组，7～10分的划分为家庭功能良好组。
1.2.2　相关定义及诊断标准
（1）本研究采用《中国LM诊治指南》[1]中的LM定义，即符合其中任意一项，即可诊断或报告为LM。
（2）CAD是指调查对象同时存在抑郁和焦虑症状，本研究以EPDS>9.5且GAD-7≥5分认为是抑郁焦虑共患[6]。
（3）泌乳量：产妇主观评价母乳是否能满足婴儿的需要。泌乳量少：指产妇泌乳量不能满足婴儿营养需要，需要其他食物补充；泌乳量中：指产妇泌乳量基本满足婴儿营养需要，婴儿基本不需要其他食物补充；泌乳量多：指产妇泌乳量超过婴儿营养需要，多余母乳需要排出体外[10]。
1.2.3　调查方式
由经过统一培训的调查人员对进入队列的孕妇进行基线资料收集。产后由产科医生通过电话密切随访产妇LM发生情况，同时使用微信发送线上问卷收集产后相关资料。
1.3　统计学分析
将数据录入Excel软件。计量资料采用（）或［M（P25，P75）］描述，计数资料使用频数和百分比(%)描述。使用SPSS.26.0软件，单因素分析采用χ2检验进行分析，将单因素分析有意义的变量纳入二元logistic回归模型。所有统计检验均为双侧检验，检验水准α=0.05。
2　结果
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2.1　LM患者基本资料
本研究纳入了726例孕32～42周孕妇进入队列，剔除数据不完整的102例孕妇资料，最终有624例孕妇被纳入到本研究中。随访期间共196例发生LM，发生率为31.41%。LM产妇年龄范围为21～40岁，平均年龄为(31.26±3.83)岁。
2.2　产妇的不同特征与LM发生的单因素分析
对乳腺炎组和对照组产妇的不同特征进行单因素分析，结果显示产妇的产次、是否乳头皲裂、泌乳量、婴儿含接姿势、家庭功能、CAD检出情况在两组之间差异有统计学意义。见表1。
2.3　产妇LM发生的二元logistic回归分析
为减少自变量之间的混杂效应造成结果误差，影响模型的稳定性，在进行二元logistic回归分析之前需要进行多重共线性检验，变量赋值说明表见表2。多重共线性检验显示，单因素分析中具有统计学意义的6个变量的VIF值均<5、TOL值均>0.1，提示此6个变量不存在多重共线性，将变量纳入二元条件logistic回归分析方程中，因变量为是否发生LM。结果显示产次为初产、乳头发生皲裂、乳汁分泌多、家庭功能障碍、产后CAD检出是产妇发生LM的危险因素。logistic回归分析结果见表3。Hosmer-Lemeshow检验显示χ2=5.746，P=0.570，提示模型拟合度较好。
2.4　LM患者在孕晚期和产后CAD检出情况
LM患者在孕晚期CAD检出率为18.9%(37/196)，在产后42 d CAD检出率为32.7%(64/196)，其中有22例LM患者孕期CAD症状持续到了产后。χ2检验结果表明LM患者孕晚期检出CAD与产后检出CAD之间存在关联(χ2=14.904, P<0.05),系数为0.276。见表4。
3　讨论
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3.1　LM发生率较高
本研究中产妇LM的发生率为31.41%，高于国内Tang[17]、邓媛[10]罗玉群[18]等的研究，可能与研究人群纳入了经通乳师通乳等非医院就诊途径缓解疼痛的LM患者有关，其次不同研究的诊断标准、调查方式等也会造成发生率差异。总体而言，产妇LM发生率较高，提示产妇产后的LM问题应引起重视。
3.2　产妇LM发生的影响因素分析
logistic回归分析结果显示，相较于经产妇，初产妇因为缺乏哺乳经验更容易发生LM，与既往的研究结果一致[19]。可能与初产妇在分娩后未做好充足的母乳喂养准备，缺乏专业的母乳喂养知识和技能有关[20]。产妇乳头发生皲裂是LM最常见的危险因素，发生机制可能与受损的乳头容易被病原体入侵引发炎症反应有关，也与产妇因为乳头疼痛难以坚持母乳喂养，不能及时排出母乳，导致乳汁淤积有关[21-22]。泌乳量多是产妇发生LM的危险因素，当产妇通过吸乳器吸乳、乳房按摩等方式过度刺激乳房时容易造成母乳分泌量超过婴儿实际需要量，多余的母乳未及时排出乳房，从而引发组织水肿和炎症反应[5]。也有部分产妇自诉哺乳期间饮食过于油腻，导致泌乳量多，本研究未详细调查产妇的饮食情况，但有关研究表明LM患者膳食结构不均衡，膳食炎症水平较高，提示哺乳期饮食与泌乳量息息相关[23]。
本研究中，家庭功能障碍是产妇LM发生的危险因素，与其他研究一致[3]。在我国的社会文化背景下，良好的家庭功能是产妇获得外界支持的重要支撑，可以使产妇在母乳喂养过程中获得足够的情感支持和信息支持，以从容应对哺乳过程中的困难。但在产妇母乳喂养过程中，家庭成员对母乳喂养的认知常常存在不同程度的滞后性和局限性，易与产妇的母乳喂养观念发生冲突，不能为产妇母乳喂养提供有效帮助。因此要发挥家庭成员在防范LM工作中的关键作用，强调家庭成员掌握科学哺乳知识的重要性，更新家庭成员的育儿理念，重点指导丈夫角色主动学习母乳喂养知识和技巧，及时为产妇提供支持，减少产妇LM的发生。
研究结果显示产后CAD是产妇发生LM的危险因素，与既往研究结果相似[19,24]。可能与产后CAD会降低机体的免疫水平，增加LM的易感性有关[25]。进一步分析LM患者孕晚期CAD与产后CAD检出之间的关系，结果提示孕期CAD会影响产后CAD，可早期干预孕妇的CAD症状，从而降低产后LM的发生率。孕期和产后抑郁焦虑情绪是由多种因素引起的，甚至与LM的其它影响因素相互关联，筛查并干预孕产妇的抑郁焦虑情绪可有效减少LM等母乳喂养问题的发生。目前部分地区的医疗机构已经在开展围产期心理健康问题筛查试点工作，并取得较好的效果。因此各地区可开展更大范围的围产期心理筛查工作，探索将围产期心理健康问题筛查和干预项目纳入常规的孕检工作中，持续为孕产妇提供心理支持，维护母婴健康。
本研究较为系统的探讨了LM发病的影响因素，提示在LM的干预工作中，应建立健全医院、社区、家庭三位一体的母乳喂养支持系统，将母乳喂养咨询指导涵盖围产期全过程，并在产前和产后分别针对产妇存在的危险因素提供个性化的支持服务。在产前阶段医院和社区开展母乳喂养宣教工作时应重视孕妇及家庭成员母乳喂养知识的掌握和哺乳技能的学习，其中初次怀孕的妇女和存在母乳喂养困难的孕妇是宣教的重点人群，并在分娩前综合评估孕妇母乳喂养的准备程度，指导准备度不足的孕妇及家庭成员及时学习和掌握母乳喂养知识和技能，便于早期防范LM。产后阶段医院和社区应在随访过程中应结合母乳喂养实际情况向产妇及家庭成员提供支持，内容应涵盖产妇的饮食、睡眠、心理、哺乳等方方面面的问题，为产妇的母乳喂养过程保驾护航。本研究的局限性在于仅在一家三甲医院进行，研究对象可能存在选择偏倚，导致研究结果外推性有限，未来的研究可考虑进行多中心研究，并优化研究设计，进一步为提升孕产期保健服务提供依据。
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doi: 10.20043/j.cnki.MPM.202412116
  • 接收时间：2024-12-10
  • 首发时间：2026-03-16
  • 出版时间：2025-08-10
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  • 收稿日期：2024-12-10
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    1.新疆医科大学公共卫生学院，新疆 乌鲁木齐 830017
    2.新疆第二医学院公共卫生学院，新疆 克拉玛依 834000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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