不同类型内分泌药物治疗对乳腺癌患者骨代谢的影响

目的 观察不同类型内分泌药物治疗对乳腺癌患者术后骨代谢水平的影响。方法 收集2013年5月至2019年1月南方医科大学附属小榄医院治疗的乳腺癌患者239例，按照内分泌治疗药物不同分为A组（采用他莫昔芬治疗，75例）、B组（采用氟维司群治疗，83例）和C组（采用依西美坦治疗，81例）。比较各组治疗前及治疗12个月降钙素（CT）、骨钙素（BGP）、骨碱性磷酸酶（BAP）和甲状旁腺素（PTH）水平，同时检测各组腰椎骨密度（BMP）并比较。结果 治疗前，三组CT、BGP、BAP、PTH和BMP值比较，差异均无统计学意义（P>0.05）；治疗后，三组CT均不同程度升高，其中C组升幅最大，A组升幅最小，组间差值比较，差异有统计学意义（P=0.009）；三组BGP均不同程度升高，其中A组升幅最大，B组升幅最小，组间差值比较，差异有统计学意义（P=0.005）；三组BAP均不同程度降低，其中B组降幅最大，A组降幅最小，组间差值比较，差异有统计学意义（P=0.018）；三组PTH均不同程度降低，其中C组降幅最大，A组降幅最小，组间差值比较，差异有统计学意义（P=0.025）。治疗后，A组腰椎BMP未见明显降低，但C组腰椎BMP下降较明显，三组间BMP治疗前后差值比较，差异有统计学意义（P=0.022）。结论 不同内分泌治疗药物均可导致乳腺癌患者BMP降低，但他莫昔芬对患者骨代谢水平影响程度较小。

Effect of different types of endocrine therapy on bone metabolism in patients with breast cancer

Objective To observe the effects of different types of endocrine therapy on bone metabolism in advanced breast cancer patients.Methods A total of 239 cases breast cancer patients with endocrine treatment were collected from May 2013 to January 2019 in Southern Medical University Affiliated Xiaolan Hospital. According to endocrine therapy, all patients were divided into group A (tamoxifen, 83 cases), group B (fulvestrant, 75 cases) and group C (exemestane, 81 cases). The biochemical markers of bone metabolism, including calcitonin, osteocalcin, bone alkaline phosphatase and parathyroid hormone were detected before and after 12 months treatment. Lumbar vertebral bone density (BMP) was measured at the base and 12 months after treatment. Results Before treatment, the values of CT, BGP, BAP, PTH and BMP in three groups were compared, and the differences were not statistically significant (P>0.05). After treatment, CT value of the three groups increased in different degrees, group C had the largest increase range and group A had the smallest increase range, and the absolute value of difference between the groups was statistically significant (P=0.009). After treatment, BGP value of the three groups rose in different degrees, group A had the largest increase range and group B had the smallest increase range, and the absolute value of difference between the groups was statistically significant (P=0.005). After treatment, BAP value of the three groups decreased in different degrees, with the largest reduction in group B and the smallest in group A, and the absolute value of difference between the groups was statistically significant (P=0.018). After treatment, PTH value of the three groups decreased in different degrees, with the greatest reduction in group C and the smallest in group A, and the absolute value of difference between groups was statistically significant (P=0.025). After treatment, there was statistically significant difference in lumbar BMP value between the three groups (P=0.007). Among them, there was no significant decrease in lumbar bone density in group A, while the most significant decrease was detected in lumbar bone density in group C, and the absolute value of difference between the groups was statistically significant (P=0.022). Conclusions Endocrine therapy treatment for breast cancer may result in decreased bone density and increased incidence of bone adverse events, but tamoxifen has the least impact on bone metabolism.