定量CT评估乳腺癌患者内分泌治疗期间身体组分变化研究

Study on the QCT in assessing the change of body constituents of patients with breast cancer during endocrine therapy

目的:利用定量CT(QCT)监测乳腺癌患者内分泌治疗期间身体组分变化情况,探讨内分泌治疗对身体组分的影响。方法:分析在医院接受辅助内分泌治疗的50例乳腺癌术后患者,于内分泌治疗前后分别接受QCT检查,测量患者内分泌治疗前后的各QCT参数值及差值,包括L1及L2骨密度(BMD)值、L3水平椎后肌肉面积(MA)、肝脏脂肪含量(LFC)、皮下脂肪面积(SFA)及内脏脂肪面积(VFA);观察内分泌治疗前后,骨质疏松患者及内脏型肥胖患者数量变化趋势。结果:经内分泌治疗,50例乳腺癌患者BMD呈下降趋势,差异具有统计学意义(t=15.373,P<0.05);LFC及VFA与治疗前相比呈上升趋势,差异具有统计学意义(Z=-4.88,Z=-5.952;P<0.05)。内分泌治疗后患者MA及SFA差异与治疗前相比,无统计学差异。内分泌治疗前后,BMD正常患者比例明显下降,骨质疏松患者数量呈上升趋势,差异有统计学意义(x2=6.658,x2=4.396;P<0.05);治疗后低骨量患者及内脏型肥胖患者数量均高于治疗前,但差异无统计学意义。结论:乳腺癌患者经过内分泌治疗后会出现骨质含量减少、肝脏及内脏脂肪含量增加,QCT可定量监测上述参数变化,有助于患者的健康体重管理。

Objective: To monitor the change of body constituents of patients with breast cancer during endocrine therapy by using quantitative computed tomography(QCT) method, so as to investigate the effect of endocrine therapy on the body constituents. Methods: Retrospectively analysis was performed on 50 postoperative patients with breast cancer who had received adjuvant endocrine therapy in Anhui provincial cancer hospital. All patients had received QCT examination before and after endocrine therapy, and the QCT parameter values and difference value before and after endocrine therapy were measured, which included L1 and L2 bone mineral density(BMD), L3 level paravertebral muscle area(MA), liver fat content(LFC), subcutaneous fat area(SFA) and visceral fat area(VFA).The variation trend of the number of patients with osteoporosis and patients with viscera-type obesity were further observed. Results: After endocrine therapy, the BMDs of 50 patients with breast cancer appeared declining trend, and the difference was significant(t=15.373, P<0.05). Compared with LFC and VFA before endocrine therapy, those after endocrine therapy appeared upward trend, and the differences of them were significant(Z=-4.88, Z=5.952, P<0.05).There were no significant in MA and SFA of patients between before and after endocrine therapy(P>0.05). The ratio of patients with normal BMD significantly declined and the number of patients with osteoporosis appeared upward trend after endocrine therapy, and the differences of them between before and after therapy were significant(x2=6.658,x2=4.396, P<0.05). Both the number of patients with low bone mass and that of patients with viscera-type obesity after therapy were higher than those before therapy, while the differences of them between before and after therapy were no significant. Conclusion: After endocrine therapy, the content of bone mass of patients with breast cancer will occur reduction but the contents of liver fat and visceral fat of them will increase. QCT can quantitatively monitor the changes of the above parameters, which is helpful to the management of healthy weight of patients.