目的：观察耳针干预乳腺癌芳香化酶抑制剂治疗所致肌肉骨关节疼痛的临床疗效。方法将140例接受芳香化酶抑制剂治疗所致肌肉骨关节疼痛的乳腺癌患者随机分为A组、B组、C组和D组,每组35例。A组采用耳针配合唑来膦酸静脉滴注治疗,B组采用单纯耳针治疗,C组采用单纯唑来膦酸静脉滴注治疗,D组采用口服碳酸钙D3咀嚼片和阿法骨化醇软胶囊治疗。观察各组治疗前后简明疼痛量表评分,并比较各组治疗前后腰椎骨密度。结果 A组和B组治疗3、6、12星期后及治疗后6星期疼痛干扰评分与同组治疗前比较,差异均具有统计学意义(P＜0.01)。A组和B组治疗3、6、12星期后及治疗后6星期疼痛干扰评分与C组和D组比较,差异均具有统计学意义(P＜0.01)。A组和B组治疗3、6、12星期后最严重时的疼痛评分与同组治疗前比较,差异均具有统计学意义(P＜0.05)。A组和B组治疗6、12星期后最严重时的疼痛评分与C组和D组比较,差异均具有统计学意义(P＜0.05)。B组治疗3星期后最严重时的疼痛评分与C组和D组比较,差异均具有统计学意义(P＜0.05)。各组治疗12星期及治疗后6星期BMD T-Score与同组治疗前比较,差异均无统计学意义(P＞0.05)。结论耳针能明显缓解芳香化酶抑制剂引起的肌肉骨关节疼痛,且疼痛改善与骨密度无关,但停止治疗后患者肌肉骨关节疼痛症状再次出现。唑来膦酸不能缓解疼痛,耳针配合唑来膦酸对缓解疼痛的疗效并不优于单独耳针治疗。%Objective To investigate the clinical efficacy of acupuncture intervention in muscle, bone and joint pain caused by aromatase inhibitors in the treatment of breast cancer. Method One hundred and forty breast cancer patients with aromatase inhibitors-caused muscle, bone and joint pain were randomly allocated to groups A, B, C and D, 35 cases each. group A received ear acupuncture plus the intravenous drip of zoledronic acid;group B, ear acupuncture alone;group C, the intravenous drip of zoledronic acid alone;group D, oral administration of calcium carbonate and vitamin D3 chewable tablets and alfacalcidol soft capsules. The Brief Pain Inventory score was observed in every group before and after treatment. Bone mineral densities of the lumbar vertebrae were compared between the groups before and after treatment. Result In groups a and B, there was a statistically significant difference in the pain interference score at three, six and twelve weeks of treatment and at six weeks after the end of treatment compared with before treatment (P<0.01). At three, six and twelve weeks of treatment and at six weeks after the end of treatment, there was a statistically significant difference in the pain interference score between group A or B and group C or D (P<0.01). In groups a and B, there was a statistically significant difference in the pain score during the most severe pain at three, six and twelve weeks of treatment compared with before treatment (P<0.05). At three, six and twelve weeks of treatment, there was a statistically significant difference in the pain score during the most severe pain between group A or B and group C or D (P<0.05). At three weeks of treatment, there was a statistically significant difference in the pain score during the most severe pain between group B and group C or D (P<0.05). In every group, there was no statistically significant difference in BMD T-score at twelve weeks of treatment and at six weeks after the end of treatment compared with before treatment (P>0.05). Conclusion Ear acupuncture can significantly relieve muscle, bone and joint pain caused by aromatase inhibitors and the pain relief is not related to bone mineral density, but muscle, bone and joint pain recurs in the patients after the treatment is discontinued. Zoledronic acid can not relieve the pain. Ear acupuncture plus zoledronic acid is not more effective than ear acupunctura alone in relieving the pain.
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