目的 了解中日友好医院因骨质疏松症处方双膦酸盐(bisphosphonates,BPs)患者对BPs疗程的认知和口服BPs用药持续性、依从性,以及影响用药持续性、依从性的因素。方法 以中日友好医院2014年1月1日至12月31日所有包含BPs(包括口服和静脉剂...目的 了解中日友好医院因骨质疏松症处方双膦酸盐(bisphosphonates,BPs)患者对BPs疗程的认知和口服BPs用药持续性、依从性,以及影响用药持续性、依从性的因素。方法 以中日友好医院2014年1月1日至12月31日所有包含BPs(包括口服和静脉剂型)的处方为线索,对因骨质疏松症用药患者进行电话访谈。了解患者实际用药情况和不愿坚持长期用药的原因。结果 在1 395例接受电话访谈的患者中,口服BPs 1 193例(85.52%),静脉应用唑来膦酸钠注射液202例(14.48%)。其中计划或已经完成至少3年治疗者占25.98%,不了解BPs疗程者占74.02%。处方过口服BPs的患者中至少43.04%存在MPR<80%或用药时间<12个月的情况;在已经停用口服BPs的患者中用药少于6个月者占51.81%。Logistic回归分析提示患者对药物疗程认知越好( OR =9.75,95% CI :4.29~22.12, P <0.01 ),处方医生级别越高( OR =2.46,95% CI :1.60~3.79, P <0.01),并发疾病越多( OR =2.01,95% CI :1.12~3.61, P =0.02)及应用糖皮质激素( OR =1.80,95% CI :1.05~3.07, P =0.03)的患者口服BPs依从性和持续性越好。简单告知其BPs应该长期应用后,愿意接受长期治疗者占66.92%,不能接受长期治疗的主要原因是担心药物不良反应(42.27%)。结论在中日友好医院因骨质疏松症应用口服BPs的患者中,达到良好用药依从性和持续性的比例很低。加强对患者的宣教和药物安全性的解释可能有助于改变这一现状。展开更多
Background A satisfactory animal model of breast cancer metastasizing to bone is unavailable. In this study, we used human breast cancer stem-like cells and human bone to build a novel “human-source” model of human ...Background A satisfactory animal model of breast cancer metastasizing to bone is unavailable. In this study, we used human breast cancer stem-like cells and human bone to build a novel “human-source” model of human breast cancer skeletal metastasis. Methods Human breast cancer stem-like cells, the CD44^＋/CD24^-/lower subpopulation, was separated and cultured. Before injection with the stem-like cells, mice were implanted with human bone in the right or left dorsal flanks. Animals in Groups A, B, and C were injected with 1×10^5, 1×10^6 human breast cancer stem-like cells, and 1×10^6 parental MDA-MB-231 cells, respectively. A positive control group （D） without implantation of human bone was also injected with 1×10^6 MDA-MB-231 cells. Immunohistochemistry was performed for determination of CD34, CD105, smooth muscle antibody, CD44, CD24, cytokine, CXC chemokine receptor-4 （CXCR4）, and osteopontin （OPN）. mRNA levels of CD44, CD24, CXCR4, and OPN in bone metastasis tissues were analyzed by real-time quantitative polymerase chain reaction （PCR）.Results Our results demonstrated that cells in implanted human bones of group B, which received 1×10^6 cancer stem-like cells, stained strongly positive for CD44, CXCR4, and OPN, whereas those of other groups showed no or minimum staining. Moreover, group B had the highest incidence of human bone metastasis （77.8%, P=0.0230） and no accompaniment of other tissue metastasis. The real-time PCR showed an increase of CD44, CXCR4, and OPN mRNA in metastatic bone tissues in group B compared with those of groups C and D, however the expression of CD24 mRNA in group B were the lowest. Conclusions In the novel “human source” model of breast cancer, breast cancer stem-like cells demonstrated a higher human bone-seeking ability. Its mechanism might be related to the higher expressions of CD44, CXCR4, and OPN, and the lower expression of CD24 in breast cancer stem-like cells.展开更多
文摘目的 了解中日友好医院因骨质疏松症处方双膦酸盐(bisphosphonates,BPs)患者对BPs疗程的认知和口服BPs用药持续性、依从性,以及影响用药持续性、依从性的因素。方法 以中日友好医院2014年1月1日至12月31日所有包含BPs(包括口服和静脉剂型)的处方为线索,对因骨质疏松症用药患者进行电话访谈。了解患者实际用药情况和不愿坚持长期用药的原因。结果 在1 395例接受电话访谈的患者中,口服BPs 1 193例(85.52%),静脉应用唑来膦酸钠注射液202例(14.48%)。其中计划或已经完成至少3年治疗者占25.98%,不了解BPs疗程者占74.02%。处方过口服BPs的患者中至少43.04%存在MPR<80%或用药时间<12个月的情况;在已经停用口服BPs的患者中用药少于6个月者占51.81%。Logistic回归分析提示患者对药物疗程认知越好( OR =9.75,95% CI :4.29~22.12, P <0.01 ),处方医生级别越高( OR =2.46,95% CI :1.60~3.79, P <0.01),并发疾病越多( OR =2.01,95% CI :1.12~3.61, P =0.02)及应用糖皮质激素( OR =1.80,95% CI :1.05~3.07, P =0.03)的患者口服BPs依从性和持续性越好。简单告知其BPs应该长期应用后,愿意接受长期治疗者占66.92%,不能接受长期治疗的主要原因是担心药物不良反应(42.27%)。结论在中日友好医院因骨质疏松症应用口服BPs的患者中,达到良好用药依从性和持续性的比例很低。加强对患者的宣教和药物安全性的解释可能有助于改变这一现状。
基金This work was supported by grants from National Natural Science Foundation of China （No. 300740076）, Jiangsu Six Kinds of Outstanding Talents Foundation （No. 2006B070）, Jiangsu Science and Education for Health Foundation （No. RC2007054） and Jiangsu Province Post-doctor Foundation （No. 0601048B）.
文摘Background A satisfactory animal model of breast cancer metastasizing to bone is unavailable. In this study, we used human breast cancer stem-like cells and human bone to build a novel “human-source” model of human breast cancer skeletal metastasis. Methods Human breast cancer stem-like cells, the CD44^＋/CD24^-/lower subpopulation, was separated and cultured. Before injection with the stem-like cells, mice were implanted with human bone in the right or left dorsal flanks. Animals in Groups A, B, and C were injected with 1×10^5, 1×10^6 human breast cancer stem-like cells, and 1×10^6 parental MDA-MB-231 cells, respectively. A positive control group （D） without implantation of human bone was also injected with 1×10^6 MDA-MB-231 cells. Immunohistochemistry was performed for determination of CD34, CD105, smooth muscle antibody, CD44, CD24, cytokine, CXC chemokine receptor-4 （CXCR4）, and osteopontin （OPN）. mRNA levels of CD44, CD24, CXCR4, and OPN in bone metastasis tissues were analyzed by real-time quantitative polymerase chain reaction （PCR）.Results Our results demonstrated that cells in implanted human bones of group B, which received 1×10^6 cancer stem-like cells, stained strongly positive for CD44, CXCR4, and OPN, whereas those of other groups showed no or minimum staining. Moreover, group B had the highest incidence of human bone metastasis （77.8%, P=0.0230） and no accompaniment of other tissue metastasis. The real-time PCR showed an increase of CD44, CXCR4, and OPN mRNA in metastatic bone tissues in group B compared with those of groups C and D, however the expression of CD24 mRNA in group B were the lowest. Conclusions In the novel “human source” model of breast cancer, breast cancer stem-like cells demonstrated a higher human bone-seeking ability. Its mechanism might be related to the higher expressions of CD44, CXCR4, and OPN, and the lower expression of CD24 in breast cancer stem-like cells.
