中国骨质疏松杂志
中國骨質疏鬆雜誌
중국골질소송잡지
CHINESE JOURNAL OF OSTEOPOROSIS
2015年
4期
463-466
,共4页
唑来膦酸%绝经后乳腺癌%化疗%内分泌治疗%骨质疏松
唑來膦痠%絕經後乳腺癌%化療%內分泌治療%骨質疏鬆
서래련산%절경후유선암%화료%내분비치료%골질소송
Zoledronate%Postmenopausal breast cancer%Chemotherapy%Endocrine therapy%Osteoporosis
目的：探讨唑来膦酸治疗绝经后乳腺癌患者术后骨质疏松的临床疗效和安全性。方法2012年2月－2013年2月我院肿瘤科接诊绝经后乳腺癌术后治疗患者68例，其中雌激素受体（ ER）阳性者60例，均在术后行4周期多西紫杉醇序贯4周期环磷酰胺联合表阿霉素辅助化疗，化疗后采用第三代芳香化酶抑制剂阿那曲唑内分泌治疗10个月，随访14个月。治疗开始时即采用随机数字表随机选取患者入组，30例入研究组，即从化疗开始前经过肾功能和血钙测试合格后即静脉给予唑来膦酸5 mg静脉输注同时联合钙剂健骨治疗14个月。另30例入对照组，化疗开始后仅常规使用钙剂健骨14个月。所有患者化疗前均行肾功能血钙测试，双光子骨密度检查，并在化疗与内分泌治疗后和随访期间使用VAS评分评定四肢骨关节疼痛程度，复查X光平片、骨密度检查。所有指标的测量结果使用软件包SPSS 13．0进行统计分析。结果随访14个月，两组患者各有1例失访，无再手术病例。研究组最终骨密度与首次化疗前相比增加者24例（82．8％）；而对照组仅为4例（13．7％），组间相比有显著差异（卡方检验，P＜0．01）；内分泌治疗后四肢疼痛VAS评估，研究组内分泌治疗后4周为（7．18±0．32）分，随访终结时为（3．45±0．31）分，对照组内分泌治疗后4周为（7．22±0．41）分，随访终结时为（6．93±1．34）分，两组患者骨质疏松造成骨痛的改善程度存在显著差异；影像学分析研究组1例出现骨质疏松相关病理性腰椎压缩骨折（3．45％），而对照组2例出现病理性腰椎压缩骨折（6．89％），骨折发生率两者相比存在显著差异（卡方检验，P＜0．01）。结论唑来膦酸联合钙剂的综合健骨治疗可以预防绝经后乳腺癌患者术后治疗期间骨质疏松的发生，显著降低此类患者术后治疗期间骨质疏松相关的严重骨痛和椎体骨折。
目的：探討唑來膦痠治療絕經後乳腺癌患者術後骨質疏鬆的臨床療效和安全性。方法2012年2月－2013年2月我院腫瘤科接診絕經後乳腺癌術後治療患者68例，其中雌激素受體（ ER）暘性者60例，均在術後行4週期多西紫杉醇序貫4週期環燐酰胺聯閤錶阿黴素輔助化療，化療後採用第三代芳香化酶抑製劑阿那麯唑內分泌治療10箇月，隨訪14箇月。治療開始時即採用隨機數字錶隨機選取患者入組，30例入研究組，即從化療開始前經過腎功能和血鈣測試閤格後即靜脈給予唑來膦痠5 mg靜脈輸註同時聯閤鈣劑健骨治療14箇月。另30例入對照組，化療開始後僅常規使用鈣劑健骨14箇月。所有患者化療前均行腎功能血鈣測試，雙光子骨密度檢查，併在化療與內分泌治療後和隨訪期間使用VAS評分評定四肢骨關節疼痛程度，複查X光平片、骨密度檢查。所有指標的測量結果使用軟件包SPSS 13．0進行統計分析。結果隨訪14箇月，兩組患者各有1例失訪，無再手術病例。研究組最終骨密度與首次化療前相比增加者24例（82．8％）；而對照組僅為4例（13．7％），組間相比有顯著差異（卡方檢驗，P＜0．01）；內分泌治療後四肢疼痛VAS評估，研究組內分泌治療後4週為（7．18±0．32）分，隨訪終結時為（3．45±0．31）分，對照組內分泌治療後4週為（7．22±0．41）分，隨訪終結時為（6．93±1．34）分，兩組患者骨質疏鬆造成骨痛的改善程度存在顯著差異；影像學分析研究組1例齣現骨質疏鬆相關病理性腰椎壓縮骨摺（3．45％），而對照組2例齣現病理性腰椎壓縮骨摺（6．89％），骨摺髮生率兩者相比存在顯著差異（卡方檢驗，P＜0．01）。結論唑來膦痠聯閤鈣劑的綜閤健骨治療可以預防絕經後乳腺癌患者術後治療期間骨質疏鬆的髮生，顯著降低此類患者術後治療期間骨質疏鬆相關的嚴重骨痛和椎體骨摺。
목적：탐토서래련산치료절경후유선암환자술후골질소송적림상료효화안전성。방법2012년2월－2013년2월아원종류과접진절경후유선암술후치료환자68례，기중자격소수체（ ER）양성자60례，균재술후행4주기다서자삼순서관4주기배린선알연합표아매소보조화료，화료후채용제삼대방향화매억제제아나곡서내분비치료10개월，수방14개월。치료개시시즉채용수궤수자표수궤선취환자입조，30례입연구조，즉종화료개시전경과신공능화혈개측시합격후즉정맥급여서래련산5 mg정맥수주동시연합개제건골치료14개월。령30례입대조조，화료개시후부상규사용개제건골14개월。소유환자화료전균행신공능혈개측시，쌍광자골밀도검사，병재화료여내분비치료후화수방기간사용VAS평분평정사지골관절동통정도，복사X광평편、골밀도검사。소유지표적측량결과사용연건포SPSS 13．0진행통계분석。결과수방14개월，량조환자각유1례실방，무재수술병례。연구조최종골밀도여수차화료전상비증가자24례（82．8％）；이대조조부위4례（13．7％），조간상비유현저차이（잡방검험，P＜0．01）；내분비치료후사지동통VAS평고，연구조내분비치료후4주위（7．18±0．32）분，수방종결시위（3．45±0．31）분，대조조내분비치료후4주위（7．22±0．41）분，수방종결시위（6．93±1．34）분，량조환자골질소송조성골통적개선정도존재현저차이；영상학분석연구조1례출현골질소송상관병이성요추압축골절（3．45％），이대조조2례출현병이성요추압축골절（6．89％），골절발생솔량자상비존재현저차이（잡방검험，P＜0．01）。결론서래련산연합개제적종합건골치료가이예방절경후유선암환자술후치료기간골질소송적발생，현저강저차류환자술후치료기간골질소송상관적엄중골통화추체골절。
Objective To observe the efficacy and safety of zoledronate for the treatment of osteoporosis after chemo-therapy and endocrine-therapy in postmenopausal breast cancer ( PBC) patients.Methods From Feb 2012 to Feb 2013, 68 PBC cases were admitted in oncology department in our hospital after surgery.Among them, 60 cases were estrogen receptor ( ER) positive.All 60 cases were treated with routine chemo-therapy and sequential endocrine-therapy and were successfully followed up for 14 months.At the beginning of the treatment, 30 cases with normal renal function were randomly selected as study group and treated with 5 mg intravenous zoledronate accompanied with oral calcium for 14 months.Other 30 cases were selected in control group and treated with calcium alone for 14 months.Renal function, serum calcium, bone mineral density ( BMD) , vision analogue scale ( VAS) and X-ray lumbar images were checked before the initial of chemotherapy and during the follow-up.All results were analyzed statistically using a SPSS 13.0 software.Results One case was missed in each group during the follow up.No case was re-operated.Patients with increase of BMD after chemotherapy were 24 cases (82.8%) in study group, and only 4 cases (13.7%) in control group. The difference between the groups was significant ( P<0.01) .The VAS score after 4-week chemotherapy and at the final follow up was 7.18 ±0.32 and 3.45 ±0.31, respectively, in study group, and 7.22 ±0.41 and 6.93 ±1.34, respectively, in control group, which was significantly different.Image analysis revealed that 1 case in study group developed lumbar compressing fracture (3.45%), but 2 cases in control group (6.89%).The difference of fracture incidence was significantly different (P<0.01). Conclusion Zoledronate therapy combined with calcium can significantly prevent PBC patients from osteoporosis during the treatment after surgery.It significantly decreases severe bone pain and vertebral compression fracture during the treatment period.
