化疗对乳腺癌术后患者骨代谢的影响

The effects of chemotherapy on bone metabolism in breast cancer patients

目的:观察不同化疗药物对乳癌术后患者骨代谢的影响,为化疗引起的继发性骨代谢异常、骨质疏松及其并发症(骨痛和病理性骨折)的早期干预提供临床依据。方法:收集年龄在50岁以下接受化疗的乳癌术后患者120例,按不同的化疗方案T(艾素),ET(表阿霉素、艾素),ECT(表阿霉素、环磷酰胺、艾素)分为3组,每组30例。另外30例未接受化疗的乳腺癌患者为对照组。分别于治疗前、后用双能X线骨密度仪对腰椎及股骨近端行骨密度(BMD)测定,同时使用全自动生化仪器测定患者血清碱性磷酸酶(ALP)、尿钙(Ca),放免法测定骨钙素(BGP)等生化指标。结果:4组乳腺癌患者的腰椎、股骨BMD值、ALP、BGP、尿Ca等生化指标治疗前各项检测指标经方差分析显示均无显著性差异(均P>0.05);对照组治疗前后上述各项指标比较均无显著性差异(均P>0.05)。化疗后3组病例分别与对照组比较腰椎BMD、股骨BMD指标均显著下降(均P<0.05),且3化疗组下降程度也存在明显差异(均P<0.05),3化疗组间生化指标比较,除T组与ET组ALP指标无明显变化外(P>0.1),其余指标均有显著性差异(均P<0.001)。结论:化疗药物对乳腺癌术后患者骨质代谢存在明显不良影响,表现为骨吸收增高,骨质丢失增多,术后联合应用化疗药物与单一用药比较可明显加重乳癌患者的骨质丢失程度,提示乳癌术后患者接受化疗会使继发性骨质疏松及其并发症(骨痛和病理性骨折)的风险因素增高,应给予早期干预。

Objective：To investigate the influence of post surgery chemotherapies on bone metabolism in breast cancer patients.To establish the prevalence of chemotherapy-caused bone loss with osteopenia,osteoporosis and osteoporosis caused bone fracture.Methods：One hundred and twenty consecutive patients with breast cancer under 50 years were enrolled in the study.Thirty cases in each group received T,ET and ECT.Thirty breast cancer patients without chemotherapy were selected as control.Before and after chemotherapy,the bone mineral density（BMD）from dual-energy X ray examination on lumbar and femur,alkaline phosphatase（ALP）,bone gla protein（BGP） and urine calcium were compared in patients with different chemotherapeutic regimen.Results：The baseline characteristics were similar among all groups before chemotherapy.Significant differences of BMD of lumbar and femur,ALP and urine calcium were observed in breast cancer patients before and after chemotherapy,and in patients treated with T,ET and ECT（P〈0.05）.However,no significant difference of BMD of lumbar and femur,ALP and urine calcium was found in patients of 3 groups from control（P〉0.05）.Additionally,compared with control,significant decrease of lumbar,femoral MBD were observed in patients treated with T,ET and ECT（P〈0.05）.We also found significant difference of ALP between T and ECT,ET and ECT,and urine calcium among T,ET and ECT（P〈0.001）.Conclusion：Post surgery chemotherapy has great effects on bone metabolism in breast cancer patients,which is characterized by increased bone absorption,bone loss.Additionally,increased types of chemotherapy drugs can significantly increase the degree of bone absorption,bone loss.Clinical intervention should be taken early to prevent chemotherapy-caused bone loss with osteopenia,osteoporosis and osteoporosis caused bone fracture.