妇科肿瘤与乳腺癌伴绝经患者骨质疏松综合治疗的临床研究

Clinical research of comprehensive therapy for postmenopausal osteoporosis patients with gynecologic tumors or the breast cancer

目的对60例妇科肿瘤、60例乳腺癌患者放疗同时给予尼尔雌醇12w,甲孕酮4w,并于给药前后分别测定血清BGP(骨钙素)、BMC(骨矿含量)、降钙素(CT)、尿钙(Ca)与肌酐(Cr)及血清碱性磷酸酶(AKP)以观察两组病人,用尼尔雌醇防治绝经后妇科肿瘤及乳腺癌患者的骨量丢失,以改进临床工作,提高患者的生活质量和疗效。方法对60例妇科肿瘤、60例乳腺癌伴绝经患者及30例健康对照人员,应用放射免疫法检测BGP、CT,用双能X线吸收法测定BMC,用SMAC技术检测尿Ca、肌酐Cr、AKP、Ca、P等。结果血清BGP、BMC在妇科肿瘤及乳腺癌伴绝经患者比对照组明显降低,两者比较均有显著性差异(P<0.05;P<0.01);血清AKP增高,两者比较有显著性差异(P<0.05);CT较给药前升高;尿Ca、Cr较给药前降低(P<0.05及P<0.01),血Ca、P比较无明显差异。结论妇科肿瘤及乳腺癌伴绝经患者在放射治疗的同时给予尼尔雌醇、甲孕酮治疗,补充钙剂及改变生活方式可能刺激甲状腺细胞而增加了降钙素分泌,抑制了骨质的吸收,因此对妇科肿瘤及乳腺癌伴绝经患者在放射治疗的同时辅以尼尔雌醇、甲孕酮进行干预,同时监测BGP、BMC对妇科肿瘤与乳腺癌伴绝经患者骨质疏松症的预防和早期诊断,对提高疗效具有较大的理论意义和临床价值。

Abstract： Objective Sixty patients with gynecologic tumors and 60 patients with the breast cancer were treated with nylestriol for 12 weeks and medroxyprogesterone acetate for 4 weeks along with radiotherapy. Serum BGP, bone mineral content （BMC）, ealeitonin （CT）, calcium （Ca）, creatinine （Cr）, and serum alkaline phosphatase （AKP） were measured for two patient groups before and after the treatment. Nylestriol treatment was performed to prevent postmenopausal patients with gynecologic tumors or the breast cancer from bone loss, in order to improve clinical work and the life quality and the treatment efficacy of the patients. Methods The BGP and CT levels of the 60 postmenopausal patients with gynecologic tumor, and 60 with the breast cancer, and 30 healthy controls were measured using radioimmunoassay methods. BMC were measure using dual-energy x-ray absorptiometry methods. Urine Ca and serum Cr, AKP, Ca, P were measured using SMAC technique. Results The serum BGP and BMC in postmenopausal patients with gynecologic tumors or the breast cancer were apparently lower than those in the control group and the differences were statistically significant （P 〈 0. 05 ; P 〈 0.01 ）. Serum AKPs were increased compared with the control group and the differences were statistically significant. CTs were increased and urine Ca and Cr were decreased after the treatment. Serum Ca and P had no significant change before and after the treatment. Conclusion The uylestriol and medroxyprogesterone acetate treatment, Ca supplement, and changes of life style in postmenopausal patients with gynecologic tumors or the breast cancer along with radiotherapy could stimulate the thyroid cell, increase the secretion of caleitonin, and inhibit the bone absorption. So the nylestriol and medroxyprogesterone treatment to the postmenopausal patients with gynecologic tumors or the breast cancer along with radiotherapy and BGP and BMC surveillance could improve the prevention, early diagnosis, and treatment efficacy of osteoporosis.