局部放疗联合注射用因卡膦酸二钠对原发性肝癌骨转移患者的疗效和安全性分析

Efficacy and safety of local radiotherapy combined with incadronate disodium for injection in patients with bone metastasis of primary liver cancer

目的探讨局部放疗联合注射用因卡膦酸二钠对原发性肝癌骨转移患者的疗效和安全性。方法选取2019年1月至2022年1月中国人民解放军联勤保障部队第九四〇医院收治的90例原发性肝癌骨转移患者为研究对象,采用随机数字表法将患者分为对照组(局部放疗)、唑来膦酸组(局部放疗联合唑来膦酸)、因卡膦酸二钠组(局部放疗联合因卡膦酸二钠),每组各30例。比较三组患者的临床疗效和安全性。结果三组患者治疗后视觉模拟评分法(visual analogue scale,VAS)评分、血总胆红素(total bilirubin,TBIL)、谷丙转氨酶(alanine aminotransferase,ALT)、碱性磷酸酶(alkaline phosphatase,ALP)、骨碱性磷酸酶(bone alkaline phosphatase,BAP)、Ⅰ型胶原交联氨基末端肽(N-telopeptide of typeⅠcollagen,NTX)水平均显著低于本组治疗前(均P<0.05),改良Barthel指数(modified Barthel index,MBI)评分、骨密度(bone mineral density,BMD)均显著高于本组治疗前(均P<0.05)。对照组患者治疗后VAS评分、血TB、GPT、ALP、BAP、NTX水平均显著高于同期另外两组(均P<0.05),MBI评分、BMD均显著低于同期另外两组(均P<0.05),而唑来膦酸组与因卡膦酸二钠组患者治疗后上述指标比较差异均无统计学意义(均P>0.05)。三组患者不良反应均较轻微,以发热最为常见,予观察或对症处理后均缓解,唑来膦酸组患者不良反应总发生率显著高于另外两组(均P<0.05),而对照组与因卡膦酸二钠组患者不良反应总发生率比较差异无统计学意义(P>0.05)。结论局部放疗联合注射用因卡膦酸二钠能明显缓解原发性肝癌骨转移患者的骨痛,提高患者生活自理能力和BMD,改善肝功能与骨代谢水平,且安全性较高,优于局部放疗联合唑来膦酸。

Objective To investigate the efficacy and safety of local radiotherapy combined with incadronate disodium for injection in patients with bone metastasis of primary liver cancer.Method Ninety patients with bone metastasis of primary liver cancer treated in the 940Hospital of Joint Logistics Support Force of People’s Liberation Army from January 2019 to January 2022 were enrolled for the research and randomly divided into control group(local radiotherapy),zoledronic acid group(local radiotherapy combined with zoledronic acid)and incadronate disodium group(local radiotherapy combined with incadronate disodium),with 30 cases in each group.The clinical efficacy and safety among the three groups were compared.Result The visual analogue scale(VAS)score,the blood levels of total bilirubin(TBIL),alanine aminotransferase(ALT),alkaline phosphatase(ALP),bone alkaline phosphatase(BAP)and N-telopeptide of typeⅠcollagen(NTX)after treatment in the three groups were significantly lower than those before treatment(all P<0.05),and the score of modified Barthel index(MBI)and bone mineral density(BMD)were significantly higher than those before treatment(all P<0.05).The VAS score,blood levels of TBIL,ALT,ALP,BAP and NTX after treatment in control group were significantly higher than those in the other two groups in the same period(all P<0.05),and the MBI score and BMD were significantly lower than those in the other two groups in the same period(all P<0.05),while there were no significant differences in the above indexes between zoledronic acid group and incadronate disodium group(all P>0.05).The adverse reactions of the three groups were mild,and fever was the most common,which was relieved after observation or symptomatic treatment.The total incidence of adverse reaction in zoledronic acid group was significantly higher than that in the other two groups(all P<0.05),while there was no significant difference in the total incidence of adverse reaction between control group and incadronate disodium group(P>0.05).Conclusion The clinical effect of local radiotherapy combined with incadronate disodium for injection on bonemetastasis of primary liver cancer is satisfactory.It can significantly alleviate bone pain,improve self-care ability,bone mineral density,liver function and bone metabolism,and has high safety,which is better than local radiotherapy combined with zoledronic acid.