龟鹿三黄汤联合钙剂对乳腺癌内分泌治疗患者骨代谢异常的影响

Effects of Guilu Sanhuang Decoction Combined with Calcium on Bone Metabolism in Patients with Breast Cancer Treated by Endocrine Therapy

目的探讨龟鹿三黄汤联合钙剂对乳腺癌内分泌治疗肝肾亏虚证患者骨代谢异常的影响。方法采用随机数字表法将60例患者分为治疗组和对照组各30例。2组均在内分泌治疗同时口服碳酸钙D3片,治疗组在此基础上予龟鹿三黄汤,每日1剂,每日2次,口服。2组均3个月为1个疗程,连续治疗2个疗程。观察2组临床疗效,比较2组治疗前及治疗3、6个月中医证候积分、Karnofsky功能状态(KPS)评分、疼痛视觉模拟评分法(VAS)评分及血清总Ⅰ型胶原氨基端延长肽(TPⅠNP)、β-胶原特殊序列(β-CTX)、骨钙素水平。监测2组安全性指标。结果治疗3、6个月,治疗组总有效率分别为70.00%、76.67%,对照组分别为66.67%、63.33%,2组比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗3个月及治疗组治疗6个月中医证候积分明显降低(P<0.05);2组治疗同一时点比较,治疗组治疗3、6个月中医证候积分明显低于对照组(P<0.05)。与本组治疗前比较,对照组治疗3、6个月KPS评分降低(P<0.05),治疗组治疗6个月KPS评分升高(P<0.05);2组治疗同一时点KPS评分比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后3、6个月VAS评分有降低趋势,但差异无统计学意义(P>0.05);2组治疗同一时点VAS评分比较差异无统计学意义(P>0.05)。与本组治疗前比较,治疗组治疗6个月TPⅠNP、β-CTX水平降低(P<0.05),对照组治疗3个月TPⅠNP水平升高(P<0.05),对照组治疗6个月TPⅠNP、β-CTX水平升高(P<0.05);与本组治疗3个月比较,对照组治疗6个月TPⅠNP、β-CTX水平升高(P<0.05),治疗组治疗6个月TPⅠNP水平降低(P<0.05);2组治疗同一时点比较,治疗组治疗6个月TPⅠNP、β-CTX水平明显低于对照组(P<0.05)。2组均未发生严重不良反应。结论龟鹿三黄汤联合钙剂可改善乳腺癌内分泌治疗肝肾亏虚证患者骨代谢异常,有效改善骨合成及骨吸收过程。

Objective To investigate the effects and mechanism of Guilu Sanhuang Decoction combined with calcium on abnormal bone metabolism in patients with breast cancer with liver-kidney deficiency.Methods Totally 60 cases of breast cancer patients with liver-kidney deficiency were divided into observation group and control group according to random number table method,with 30 cases in each group.Both groups received oral calcium carbonate D3 tablets simultaneously during endocrine therapy.Treatment group was given Guilu Sanhuang Decoction on the basis of former treatment,one dosage per day,twice a day,orally.Three months was one treatment course,and both groups received two consecutive courses.The clinical efficacy of both groups was observed.TCM syndrome scores,Karnofsky performance status(KPS)scores,visual analogue scoring(VAS)scores,total procollageⅠN-terminal extension peptide(TPⅠNP),andβ-cross laps(β-CTX),osteocalcin levels before and 3 and 6 months of treatment were compared.Safety indicators of both groups were monitored.Results After 3 and 6 months of treatment,the total effective rates were 70.00%and 76.67%in the treatment group and 66.67%and 63.33%in the control group,respectively,without statistical significance(P>0.05).Compared with before treatment,TCM syndrome scores of the two groups for 3 months of treatment and the treatment group for 6 months of treatment were significantly reduced(P<0.05);compared with the control group at the same time point,TCM syndrome scores in the treatment group treated for 3 and 6 months were significantly lower than the control group(P<0.05).Compared with before treatment,the KPS score of the control group decreased at 3 and 6 months of treatment(P<0.05),and the KPS score of the treatment group increased at 6 months of treatment(P<0.05);the VAS scores of the two groups at the same time points of treatment had no statistical significance(P>0.05).Compared with before treatment,the VAS scores of 3 and 6 months after treatment in both groups had a decreasing trend,without statistical significance(P>0.05);both groups at different time points after treatment had no statistical significance(P>0.05).Compared with before treatment,the levels of TPⅠNP andβ-CTX in the treatment group decreased at 6 months of treatment(P<0.05),the level of TPⅠNP increased in the control group at 3 months of treatment(P<0.05),the levels of TPⅠNP andβ-CTX increased in the control group at 6 months of treatment(P<0.05).Compared with the treatment of 3 months,the levels of TPⅠNP andβ-CTX increased in the control group for treatment of 6 months(P<0.05),and the levels of TPⅠNP decreased in the treatment group for treatment of 6 months(P<0.05).Compared with the control group at the same time point,the levels of TPⅠNP andβ-CTX in the treatment group for treatment of 6 months were significantly lower than those in the control group(P<0.05).No serious adverse reactions occurred in either group.Conclusion Guilu Sanhuang Decoction combined with calcium can improve the abnormal bone metabolism caused by endocrine therapy of breast cancer with deficiency of liver and kidney,and it can improve the process of bone synthesis and bone absorption.