目的 探讨唑来膦酸早期应用对戈舍瑞林联合芳香化酶抑制剂治疗所致绝经前转移性乳腺癌患者骨丢失的作用.方法 选取2014年2月至2015年1月唐山市人民医院90例接受戈舍瑞林联合芳香化酶抑制剂治疗的绝经前转移性乳腺癌患者为研究对象,分为三组,早期治疗组(30例)在戈舍瑞林联合芳香化酶抑制剂治疗同时使用唑来膦酸;延迟治疗组(30例)在检测骨密度T值<-1.0时开始使用唑来膦酸;对照组(30例)在戈舍瑞林联合芳香化酶抑制剂治疗期间未使用唑来膦酸.通过双能X线骨密度测量仪检测各时间点各组骨密度值,采用数字评分法进行骨痛评定.各组间测量指标的差异采用SPSS18.0软件统计分析.结果 随访期间,早期治疗组治疗后第6个月、第12个月和第24个月,其腰椎和股骨颈的骨密度达到(0.955±0.146)g/cm2、(0.896±0.218)g/cm2、(0.864±0.127)g/cm2和(0.847±0.171)g/cm2、(0.820±0.138)g/cm2、(0.792±0.149)g/cm2,均明显高于对照组和延迟治疗组(P<0.05);延迟治疗组在治疗第12、24个月后腰椎和股骨颈的骨密度达到(0.854±0.142)g/cm2、(0.827±0.135)g/cm2和(0.782±0.144)g/cm2,(0.741±0.225)g/cm2,明显高于对照组,组间比较差异具有统计学意义(P<0.05);早期治疗组和延迟治疗组患者第6个月、第12个月和第24个月的肢体疼痛数字评分分别为(2.47±0.56)分、(2.87±0.90)分、(3.53±1.04)分和(3.04±1.30)分、(3.87±0.27)分、(4.04±1.15)分,显著低于对照组,组间比较差异均具有统计学意义(P<0.05).结论 早期应用唑来膦酸可预防戈舍瑞林联合芳香化酶抑制剂治疗导致绝经前乳腺癌患者的骨量丢失,缓解四肢骨痛.%Objective To explore the effects of early application of zoledronate on bone mass loss caused by goserelin combined with aromatase inhibitor therapy in patients with premenopausal breast cancer. Methods Ninety premenopausal patients with metastatic breast cancer who underwent goserelin combined with aromatase inhibitor thera-py in Tangshan People's Hospital were enrolled as the research objects. They were divided into three groups: early treat-ment group, delayed treatment group and control group, with 30 patients in each group. The early treatment group was given goserelin combined with aromatase inhibitor, along with zoledronate at the same time. The delayed treatment group was given zoledronic acid in the detection of bone mineral density T value <-1.0. The control group was also treated with goserelin combined with aromatase inhibitor, without zoledronate. At each time point, bone density of each group were de-tected by Dual energy X-ray absorptiometry, and the bone pain was evaluated by digital pointrating method. Analysis of the differences between the groups were measured by SPSS18.0 statistical software. Results During the follow-up, the bone density of the lumbar spine and femoral neck at 6 months, 12 months, and 24 months after treatment in early treatment group were (0.955±0.146) g/cm2, (0.896±0.218) g/cm2, (0.864±0.127) g/cm2 and (0.847±0.171) g/cm2, (0.820±0.138) g/cm2, (0.792±0.149) g/cm2, which were significantly higher than those in the control group and the delayed treatment group (P<0.05). The bone density of the lumbar spine and femoral neck at 12 months and 24 months after treatment in delayed treat-ment group were (0.854±0.142) g/cm2, (0.827±0.135) g/cm2 and (0.782±0.144) g/cm2, (0.741±0.225) g/cm2, which were sig-nificantly higher than those in the control group (P<0.05). The scores of limb pain at 6 months, 12 months, and 24 months after treatment in the early treatment group and delayed treatment group were (2.47±0.56), (2.87±0.90), (3.53±1.04)and (3.04±1.30), (3.87±0.27), (4.04±1.15), respectively, which were significantly lower than those in the control group (P<0.05). Conclusion Early application of zoledronate could prevent bone mass loss caused by goserelin combined with aro-matase inhibitor in the premenopausal patients with breast cancer, which can significantly alleviate limb pain.
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