首剂负荷量伊班膦酸钠治疗肺癌转移性骨痛的疗效和安全性分析

The efficiency and safety analysis of ibandronate at the initial loading dose for metastatic bone pain induced by non-small cell lung cancer

目的：探讨首剂负荷量伊班膦酸钠（ibandronate）治疗肺癌转移性骨痛的疗效和安全性。方法：回顾性分析2006年5月-2007年7月本院收治的30例接受负荷量伊班膦酸钠治疗伴骨转移的晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者，首剂给予负荷量，即6mg伊班膦酸钠以100mL 0．9％的氯化钠溶液稀释，每日1次静脉滴注，15min以上，连用3d，以后每3—4周重复给予1次维持量伊班膦酸钠6mg。观察并记录止痛起效时间、疼痛评分、生活质量评分、吗啡日消耗量、血钙、肌酐、碱性磷酸酶等变化。结果：29例可评价疗效及安全性。治疗后25例疼痛缓解，缓解率86．2％，疼痛缓解平均所需时间（2．9±0．8）d，治疗后疼痛评分显著改善，生活质量评分显著提高（P〈0．001），其中有4例治疗后吗啡用量减少20—40mg。治疗前7例血钙增高，治疗后均降为正常。不良反应经对症处理后均好转，未出现肾脏毒性反应。结论：伊班膦酸钠负荷量给药止痛起效快，不良反应轻，可明显改善转移性骨痛，提高患者的生活质量，减少吗啡用量，避免吗啡不良反应的发生，并能有效降低血钙，是NSCLC转移性骨痛治疗的一个新的选择。

Objective：To evaluate the efficiency and safety of ibandronate at the initial loading dose in the treatment of metastatic bone pain （MBP） induced by non-small cell lung cancer （NSCLC）. Methods： Thirty cases of NSCLC patients who were admitted to our hospital from May 2006 to July 2007 were retrospectively analyzed. They received loading dose of ibandronate for MBP treatment. Ibandronate was given to the patients intravenously at initial loading dose of 6 mg for more than 15 min on 3 consecutive days. Then ibandronate was administered repeatedly at 6 mg every 3 to g months. The response time, pain score, QOL score, daily morphine consumption dose were recorded. The serum markers such as calcium, creatinine, alkaline phosphatase （AKP） were monitored. Results： Twenty nine cases were eligible to evaluate the efficiency and safety. Among them, the MBP of 25 cases （86.2%） were relieved. Their average response time was 2.9 ± 0.8 days. The pain score was significantly decreased after treatment and the life qualities of patients were markedly improved （P 〈0.001 ）. The morphine consumption dose was reduced by about 20 to 40 mg in g cases after treatment. The serum calcium level increased in 7 patients before treatment and declined to the normal level after treatment. The adverse reaction was relieved after treatment and no renal toxicity was observed. Conclusion： Administration of ibandronate at initial loading dose had quick on-set and mild side effects. It could significantly relieve metastasis bone pain and improve QOL, reduce the morphine consumption dose and avoid morphine-induced adverse reaction, and effectively decrease serum calcium level. Administration of ibandronate at initial loading dose is a new promising option for treatment of the MBP in NSCLC.