乳腺癌患者骨质疏松性椎体骨折相关因素分析

Analysis of related factors of osteoporotic vertebral fracture in breast cancer patients

目的探索乳腺癌患者治疗前后的骨质疏松性椎体骨折率及相关影响因素。方法收集478例乳腺癌患者作为病例组与500例无乳腺癌病史的妇女作为对照组,采用Genant半定量方法对治疗前后的病例组和对照组胸部X线侧位片上的胸椎T4至腰椎L1进行评估,比较病例组与对照组椎体骨折率的差异,以及病例组治疗前后椎体骨折率的变化;按年龄、体质指数(BMI)、乳腺癌分子亚型(Luminal A、Luminal B、Triple-Negative及HER2+)、治疗时间、治疗方式进行分组,对影响椎体骨折的相关因素进行单因素分析及多因素Logistic回归分析。结果病例组治疗前的椎体骨折率为12.34%,治疗后的椎体骨折率为19.46%,对照组的椎体骨折率为14.40%;病例组治疗前的椎体骨折率与对照组以及病例治疗后组差异存在统计学意义(P<0.05);多因素Logistic回归分析显示年龄、治疗时间是椎体骨折的主要影响因素(P<0.05)。结论乳腺癌治疗的诸多因素都能增加骨质疏松性椎体骨折的风险,乳腺癌患者治疗后的椎体骨折率高于治疗前。

Objective To explore the osteoporotic vertebral fracture rate and related factors in breast cancer patients before and after treatment.Methods Four hundred and seventy-eight breast cancer patients were selected as case group and 500 women without breast cancer history were selected as control group.The T4-L1 vertebral bodies of the case group and the control group was evaluated before and after the treatment according to the Genant semi-quantitative method.The difference of vertebral body fracture rate between the case group and the control group,and the change of vertebral body fracture rate before and after treatment in the case group were compared.Univariate and multivariate logistic regression model was used for analysis of related factors of vertebral fracture rate in postmenopausal women with breast cancer,according to age,BMI,breast cancer molecular subtypes(Luminal A,Luminal B,Triple-Negative,and HER2+),treatment time,and treatment method.Results The prevalence of vertebral fracture was 12.34%in the case group before treatment,and 19.46%after treatment,It was 14.40%in the control group.There was a significant difference between the vertebral fracture rate of the case group before treatment and that of the control group and the case group after treatment(P<0.05).Multivariate logistic regression analysis showed that age and treatment time were the main influencing factors of vertebral fractures(P<0.05).Conclusion The incidence of vertebral fracture in breast cancer patients after treatment is higher than that before treatment because many factors of breast cancer treatment can increase the risk of osteoporotic vertebral fractures.