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| 唑来膦酸（密固达）治疗绝经后无骨转移乳腺癌患者骨质疏松的效果观察 |
| The efficacy of zoledronate on postmenopausal osteoporosis in breast cancer patients without bone metastasis |
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| DOI：10.3969/j.issn.1006.7108.2015.04.018 |
| 中文关键词: 唑来膦酸 绝经后乳腺癌 化疗 内分泌治疗 骨质疏松 |
| 英文关键词:Zoledronate Postmenopausal breast cancer Chemotherapy Endocrine therapy Osteoporosis |
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| 中文摘要: |
| 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.% )，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。 |
| 英文摘要: |
| 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. |
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