疏肝益肾法防治乳腺癌来曲唑治疗所致骨质疏松临床观察

Clinical Observation of Soothing the Liver and Tonifying the Kidney on Osteoporosis Caused by Letrozole in Breast Cancer

目的:观察评估疏肝益肾法对乳腺癌患者来曲唑治疗所致骨质疏松的临床疗效性与安全性。方法:选取绝经后乳腺癌患者48例,采用随机数字表法将其分为治疗组和对照组各24例。所有患者均口服来曲唑2.5mg,1次/d,并同时服用钙尔奇片剂1粒/d;治疗组在此基础上加服以"疏肝益肾"立法的汤药——慈菇平岩汤。分别于治疗前、治疗后对两组患者的FACT-B评分、中医症状评分、骨密度(BMD)、骨代谢指标(N-MID,CTX-I)、雌二醇水平(E2)、肿瘤标志物(CA153,CEA)进行比较,观察两组患者治疗前后各指标的变化及不良反应,并进行统计分析。结果:(1)两组患者治疗后FACT-B评分均较治疗前升高,差异有统计学意义(P<0.05);治疗组治疗后FACT-B相对应的评分均高于对照组评分,差异有统计学意义(P<0.05)。(2)治疗组治疗后相对应的中医症状评分数值较治疗前显著改善(P<0.05);对照组患者在接受治疗后相对应的中医症状评分数值与治疗前相比,差异无统计学意义(P>0.05);两组患者治疗后相对应的中医症状评分数值组间比较,治疗组相应评分显著优于对照组(P<0.05),表明治疗组患者较对照组在改善相应的中医症状方面效果更优。(3)对照组在治疗后的骨代谢指标水平较前增加(P<0.05),且骨密度值较前降低(P<0.05);治疗组治疗后的骨代谢指标水平亦有所增加(P<0.05),但骨密度并无显著降低,即患者治疗前后相应指标差异无统计学意义(P>0.05);两组患者治疗后相对应的组间骨密度数值差异无统计学意义(P>0.05)。(4)两组患者治疗前E2水平比较,差异无统计学意义(P>0.05),两组患者接受相应治疗后,其E2数值无显著改变,与治疗前相应数值比较及组间相应数值对比,其两者对应的差异均无统计学意义(P>0.05)。(5)两组患者经治疗后肿瘤标志物(CA153、CEA)均较前下降(P<0.05),且两组患者治疗前后相对应指标数值的组间对比,差异无统计学意义(P>0.05)。(6)两组患者在接受相应治疗期间均未出现明显的不适反应,且相关安全性指标均未发现明显异常。结论:疏肝益肾法对绝经后乳腺癌患者来曲唑治疗后引起的骨质疏松有较好的临床疗效,且安全性较高,有一定推广价值。

Objective:To observe and evaluate the clinical efficacy and safety of soothing the liver and tonifying the kidney method on osteoporosis caused by letrozole in breast cancer.Methods:48 postmenopausal breast cancer patients who visited the oncology department of Qinhuangdao Hospital of traditional Chinese medicine from September 2019 to February 2020 were selected.48 postmenopausal breast cancer patients treated with letrozole were random divided into treatment group and control group,24 cases in treatment group and 24 cases in control group.All patients were given letrozole 2.5 mg,once a day,and Caltrate tablets were taken at the same time.On this basis,the treatment group was additionally given Cigu Pingyan decoction,which was prescribed by“soothing the liver and tonifying the kidney”.Before and after treatment,the FACT-B score,TCM symptom score,bone mineral density(BMD),bone metabolism index(N-MID,CTX-I),estradiol level(E2),tumor markers(CA153,CEA)were compared between the two groups before and after treatment,and the changes and adverse reactions of the two groups were observed and analyzed statistically.Results:(1)After treatment,the FACT-B score of the two groups was higher than that before treatment,the difference was statistically significant(P<0.05);after treatment,the FACT-B score of the treatment group was higher than that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the corresponding TCM symptom score of the treatment group was significantly improved compared with that before treatment(P<0.05);the corresponding TCM symptom score value of the control group after treatment was compared with that before treatment,and the corresponding difference was not statistically significant(P>0.05);the corresponding TCM symptom score value of the two groups after treatment was compared between the two groups,that is,the corresponding score of the treatment group The value was significantly better than that of the control group(P<0.05),indicating that the treatment group was better than the control group in improving the corresponding TCM symptoms.(3)In the control group,the level of bone metabolism index increased after treatment(P<0.05),and bone mineral density decreased(P<0.05).After treatment,the bone metabolism index level of the treatment group also increased(P<0.05),but the bone mineral density did not significantly decrease,that is,the difference of the corresponding indicators before and after treatment was not statistically significant(P>0.05),and the corresponding bone mineral density between the two groups after treatment had no statistical significance(P>0.05).(4)There was no significant difference in E2 level between the two groups before treatment(P>0.05);after receiving the corresponding treatment,the E2 value of the two groups had no significant change,and the corresponding difference between the two groups was not statistically significant(P>0.05).(5)After treatment,the tumor markers(CA153,CEA)of the two groups decreased compared with before(P<0.05),and there was no significant difference in the corresponding index values between the two groups before and after treatment(P>0.05).(6)No significant adverse reactions were found in the two groups.Conclusion:Soothing the liver and tonifying the kidney method has a good clinical effect on osteoporosis caused by letrozole treatment of postmenopausal breast cancer,and has high safety,which has the value of further promotion and application.