绝经前乳腺癌内分泌治疗对患者骨矿物密度影响的研究

摘要

Objective:To discuss the effects of tamoxifen monotherapy and its combination with the ovarian function suppressant on bone mass loss in the premenopausal patients with early breast neoplasm so as to provide a reference for the clinical management of bone mass during the treatment of breast neoplasm with endocrine therapy. Methods:Thirty-ifve estrogen receptor-negative premenopausal patients with breast neoplasm, twenty-ifve estrogen receptor-positive premenopausal patients with breast neoplasm receiving tamoxifen monotherapy and iffteen estrogen receptor-positive premenopausal patients with breast neoplasm receiving tamoxifen combined with the ovarian function suppressant were divided into group A, B and C, respectively and their bone mineral density was measured by dual energy X-ray absorptiometry and the changes of their bone mineral density were analyzed before and after treatment. Results:The decline of bone mineral density in group B and C was more remarkable after treatment than before and furthermore the decline was more obviously in group C than in group B than in group A (P<0.05). Conclusion:An incipient bone mass loss will occur if premenopausal patients with breast neoplasm are treated with endocrine therapy, and its effect is more obvious if patients are treated with tamoxifen combined with the ovarian function suppressant.%目的：观察绝经前的早期乳腺癌患者在单用他莫昔芬以及联合使用他莫昔芬和卵巢功能抑制治疗过程中发生的骨矿物密度值下降情况，以期为临床管理乳腺癌内分泌治疗期间的患者骨矿物密度提供参考。方法：从在我院接受乳腺癌改良根治术的乳腺癌患者中选取35例雌激素和（或）孕激素受体阴性的绝经前乳腺癌患者（A组）、25例单用他莫昔芬治疗的雌激素和（或）孕激素受体阳性的绝经前乳腺癌患者（B组）、15例联合使用他莫昔芬和卵巢功能抑制治疗的雌激素和（或）孕激素受体阳性的绝经前乳腺癌患者（C组），使用双能X线骨矿物密度检测仪检测各组患者治疗前后的骨矿物密度值，分析各组患者治疗前后的骨矿物密度值变化情况并比较各组患者治疗后的骨矿物密度值变化的差异。结果：B组和C组患者治疗后的骨矿物密度值均较治疗前明显下降（P均＜0.05）；治疗后，B组患者的骨矿物密度值下降较A组明显（P均＜0.05），C组患者的骨矿物密度值下降又较B组明显（P均＜0.05）。结论：绝经前乳腺癌患者使用内分泌治疗会导致骨量丢失，而使用联合卵巢功能抑制的内分泌治疗对患者骨矿物密度的影响更明显。