三种双膦酸盐类药物对乳腺癌术后骨质疏松患者临床研究

Therapeutic effects of three kinds of bisphosphonates on postoperative osteoporosis in patients with breast cancer

目的研究伊班膦酸钠、唑来膦酸及阿伦膦酸钠三种双膦酸盐类药物对乳腺癌术后骨质疏松患者治疗的临床效果。方法选择2014年2月至2016年4月因骨痛就诊的乳腺癌术后内分泌药物治疗的135例患者,所有研究对象均为乳腺癌术后患者,术后化疗辅助内分泌治疗。按照不同的骨质疏松症治疗方案,采用随机数字表法将患者随机分为伊班膦酸钠组(A组)、阿仑膦酸钠组(B组)和唑来膦酸组(C组),每组45例。观察治疗前后的视觉模拟法(VAS划线法)评价;记录采用双能X线吸收法的骨密度测定仪测定的患者治疗前后的腰椎、股骨颈的骨密度。收集治疗过程三种患者出现的不良反应和骨折事件发生情况。结果治疗后A组总有效率为95.6%,B组总有效率为77.8%,C组总有效率为88.9%,3组比较差异有统计学意义(χ~2=8.974,P<0.05)。治疗1年后,患者的VAS评分出现不同程度降低,且腰椎、股骨颈的骨密度值均有明显提高,而且A组和C组效果好于B组的结果,差异有统计学意义(P<0.05),但A组和C组的差异无统计学意义(P>0.05)。3组不良反应发生率差异无统计学意义(P>0.05)。3组骨折发生率比较差异有统计学意义(χ~2=6.585,P<0.05)。结论伊班膦酸钠、唑来膦酸及阿伦膦酸钠均可用于乳腺癌术后骨质疏松患者的治疗,伊班膦酸钠可能具有更好的效果改善骨密度及骨质疏松症状。

Objective To observe the clinical curative effects of three kinds of bisphosphonates including ibandronate,zoledronic acid and alendronate on postoperative osteoporosis in patients with breast cancer.Methods A total of 135 patients with breast cancer who underwent postoperative endocrine medications for bone pain in our hospital from February 2014 to April 2016 were enrolled in the study.All the patients received postoperative chemotherapy-assisted endocrine therapy.These patients were randomly divided into ibandronate group(group A),alendronate group(group B)and zoledronic acid group(group C)according to different osteoporosis treatment regimens,with 45 patients in each group.The visual analog method(VAS scribing method)before and after treatment was used to evaluate patient’s data.Moreover bone mineral density of the lumbar vertebrae and femoral neck before and after treatment was measured by using dual energy X-ray absorptiometry.The adverse reactions and the incidence of bone fracture during treatment were observed and compared among the three groups.Results After treatment,the total effective rate in group A was 95.6%,which in group B was 77.8%,and 88.9%in group C,there was significant difference among the three groups(χ^2=8.974,P<0.05).There were no significant differences in VAS scores and bone mineral density between the A,B,and C groups before treatment.After 1-year treatment,the VAS scores in the three groups were decreased at different extents,and the bone mineral density of lumbar vertebrae and femoral neck was significantly increased,and the improvement effects in group A and group C were superior to those in group B(P<0.05),however,there were no significant differences between group A and group C(P>0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).However there was no significant difference in the incidence of bone fracture among the three groups(χ^2=6.585,P<0.05).Conclusion Ibandronate,zoledronic acid and alendronate can be used in treatment of postoperative osteoporosis in patients with breast cancer.Ibandronate may have better effects in improving bone mineral density and osteoporosis.