成骨性骨转移的发生机制及其诊治现状

Advancement in the Research of Osteoblastic Metastasis Molecular Mechanism,Diagnosis and Treatment

骨转移是恶性肿瘤的常见并发症,一旦发生骨转移,患者常伴有严重疼痛、病理性骨折、高钙血症及神经压迫综合症,且预后较差。骨转移是肿瘤治疗中一个严重而耗费极大的临床症状,也是近年来的研究热点之一。骨转移可分为溶骨性、成骨性及混合性骨转移。成骨性骨转移与溶骨性骨转移本质上的区别在于骨组织微环境中所释放出的细胞因子的作用不同,前者激活的细胞因子均具有促成骨作用。在临床可通过全身骨扫描、X线、CT或MRI等检查手段检测成骨性骨转移的发生。治疗成骨性骨转移不能单一应用一种方法,也不能只重视骨转移而忽视原发肿瘤的治疗,应合理选用化疗、内分泌治疗、外照射治疗、核素治疗、手术、双膦酸盐药物及止痛药物等不同的治疗方法,综合运用多学科手段治疗成骨性骨转移。

Bone is a common site of cancer metastasis. Complications of skeletal metastasis include pathological fractures, hypercaleemia, spinal cord compression, and bone pain. These conditions have a profound impact on patients＂ quality of life and lead to impaired mobility. Theretbre, the study of skeletal metastasis has been an important topic in carcinoma treatmenl. Bone metastasis can be classified into osteolytic, osteoblastic, and mixed, according to the primary mechanism of interference with normal bone remodeling. The main mechanism of osteoblastic metastasis involves cytokines which stimulate bone formation and osteoblast prolit^ration in the bone microenvironment. Osteoblastic metastasis can be detected by bone scanning, X-ray, CT and MRI. The treatment for osteoblastic metastasis includes chemotherapy, endocrine therapy, external radiation, internal radiation, surgery, and administration of bisphosphonates and analgesics. These therapies should be combined to achieve the best results.