双膦酸盐类药物相关颌骨坏死发病机制及治疗研究进展

双膦酸盐类药物相关颌骨坏死是双膦酸盐类药物一种潜在的严重副反应,发生率从0到28%不等。以患者出现缺血性骨坏死和骨暴露为典型特征,伴有明显疼痛、颌面部瘘管、甚至病理性骨折,极大地影响患者的生活质量和相关的治疗。其发病因素涉及药物本身的药理作用、创伤因素、感染因素、以及可能的致病基因带来的易感性,发病机制较为复杂。该病的治疗方法种类较多,包括全身使用抗生素、局部冲洗和含漱、手术治疗、高压氧舱、激光、自体骨髓干细胞移植等,但无一能够达到非常有效的治疗效果。本文就双膦酸盐类药物相关颌骨坏死的发病机制、临床治疗的相关研究进展进行文献综述。     

Syndrome de Tietze après traitement par biphosphonate. À propos d’un cas

We report a Tietze's syndrome after one perfusion of pamidronate used to treat a complex regional pain syndrome. This is the first time this complication is described.     

抗骨质疏松治疗的最佳他汀类药物及剂量选择的动物实验研究

目的探索具有最佳抗骨质疏松作用的他汀药物种类和药物剂量,为进一步研究他汀药物同时发挥抗骨质疏松和调脂作用提供基础。方法 40只12月龄新西兰白兔通过双侧卵巢切除和泼尼松龙诱导8周建立骨质疏松症模型,随机分为四组:生理盐水(normal saline,NS)组,瑞舒伐他汀(rosuvastatin,RSV)组,辛伐他汀(simvastatin,Sim)组,阿仑膦酸钠片(Alendronate,ALN)组。RSV组和Sim组按药物浓度梯度分为五个小组。定期测量白兔股骨骨密度(bone mineral desity,BMD)和骨钙素(bone gamma-carboxyglutamic-acid-containing proteins,BGP)、抗酒石酸酸性磷酸酶5b(tartrateresistant acid phosphatase 5b,TRACP-5b)值。结果8周末BMD较0周时明显降低(P<0.05)。12、24和36周末,RSV组、Sim组和ALN组比NS组BMD、BGP水平明显升高,TRACP-5b水平显著降低(P<0.01),并且RSV组与ALN组指标接近(P>0.05)。RSV组内中以60 mg/(kg·d)喂养时,BMD、BGP较其他组明显升高。结论他汀类药物具有抗骨质疏松的作用,效果接近唑来膦酸;亲水性瑞舒伐他汀比疏水性他汀药物作用更佳;并且剂量在60 mg/(kg·d)时效果更好。     

二膦酸盐相关性颌骨骨质坏死的影像学表现

目的：探讨二磷酸盐相关性颌骨骨质坏死的影像学特点。方法：回顾性分析5例二膦酸盐相关性颌骨骨质坏死患者的CT及曲面体层资料,所有患者均有长期大剂量静脉使用二膦酸盐类药物的病史,平均用药时间约31个月。结果：5例患者均有下颌骨病变,1例患者上颔骨同时受累,所有患者影像学表现为牙缺失,牙槽窝经久不愈或残存,牙槽骨及颌骨的骨质硬化及骨质破坏并存,伴死骨形成及软组织肿胀。结论：二膦酸盐相关性颌骨骨质坏死的影像学表现多样,影像学检查有助于本病的诊断。     

Long-term impact of chemotherapy-induced ovarian failure on bone mineral density (BMD) in premenopausal breast cancer patients. The effect of adjuvant clodronate treatment

We present the 5-year results of the effect of adjuvant chemotherapy on bone mineral density (BMD) and the efficacy of clodronate in the prevention of bone loss in 73 premenopausal women with primary breast cancer. All patients were treated with cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy. The patients were randomised to oral clodronate 1600 mg daily for 3 years or to a control group. At 5 years, patients were divided into those with preserved menstruation and those with amenorrhoea. Changes in BMD correlated significantly with the menstrual function after chemotherapy. The change in the lumbar spine BMD at 3 and 5 years were +0.6 and −1.3% in the menstruating group and −7.5 and −10.4% in the amenorrhoeic group (P=0.0001 and 0.0001, respectively), and in femoral neck +1.7 and −0.3%, and −3.5 and −5.8% (P=0.002 and P=0.001, respectively). Three-year clodronate treatment significantly reduced the bone loss in the lumbar spine −3.0% compared with controls −7.4% at three years (P=0.003), but no significant difference was found in the femoral neck: −1.7% versus −2.8%, respectively (P=0.86). These differences between the study groups were still seen at 5 years: in the lumbar spine −5.8% versus −9.7% (P=0.008) and femoral neck −3.5% versus −5.1% (P=0.91). In conclusion, chemotherapy-induced ovarian failure in premenopausal women caused a temporary accelerated bone loss of the lumbar spine. Adjuvant clodronate treatment significantly reduced this bone loss. Two years after the termination of treatment, the bone loss was still significantly less in the clodronate group compared with the control group.     

Gorham–Stout disease affecting both hands: stabilisation during biphosphonate treatment

The Gorham–Stout syndrome is a rare condition in which spontaneous, progressive resorption of bone occurs. The aetiology is poorly understood. We report a patient with osteolysis of the metacarpal bones in both hands due to an increased number of stimulated osteoclasts. This suggests that early potent antiresorptive therapy with bisphosphonates may prevent local progressive osteolysis.