二氯化锶联合锝[99Tc]亚甲基二膦酸盐治疗乳腺癌骨转移患者的临床疗效评估

目的:观察放射性核素二氯化锶(~(89)SrCl_2)联合锝[~(99)Tc]亚甲基二膦酸盐(~(99)Tc-MDP)治疗乳腺癌骨转移疼痛患者的临床疗效及对骨密度的影响。方法:选取2013年1月至2018年4月,保定市第一中心医院收治的乳腺癌骨转移患者70例为研究对象,随机分为联合组与对照组,每组35例。联合组采用~(89)SrCl_2联合~(99)Tc-MDP治疗,对照组单用~(89)SrCl_2治疗。2组患者分别于治疗前及治疗后3、6个月检测腰椎L_(2-4)及股骨颈骨密度T评分,行全身骨显像检查评价骨转移灶情况,并对患者的疼痛程度、不良反应、生存质量评分进行观察和统计。结果:治疗6个月后,联合组骨痛缓解总有效率(88.57%),骨转移灶治疗总有效率(71.43%),生存质量评分提高率(77.14%)均显著高于对照组(68.57%、45.71%、54.29%),差异具有统计学意义(P <0.05);联合组腰椎L_(2-4)及股骨颈骨密度T评分分别高于治疗前及治疗后3个月(F=27.892,F=33.662,均P<0.05);联合组腰椎L_(2-4)及股骨颈骨密度T评分高于对照组(t=5.391、t=6.687,均P<0.05)。结论:~(89)SrCl_2联合~(99)Tc-MDP治疗不仅可抑制乳腺癌骨转移灶进展,缓解疼痛,还可提高患者骨密度,治疗骨质疏松,有效防止病理性骨折,改善患者的生存质量。     

~(153)钐-乙二胺四甲基膦酸联合~(99)锝亚甲基二膦酸盐注射液治疗骨转移癌的临床观察

许多恶性肿瘤晚期常发生骨转移,如约50%的乳腺癌、80%的前列腺癌常并发骨转移癌,其中75%患者出现日益加重的剧烈骨痛,且有80%患者伴有多处疼痛[1].如何有效地控制骨痛,一直是临床医师面临的棘手问题.1989年Turner等[2]首次报道应用153钐-乙二胺四甲基膦酸(153Sm-EDTMP)治疗骨转移癌,发现其对骨转移癌有较好的止痛效果.最近,国内学者研究[3,4]发现153Sm-EDTMP与99锝亚甲基二膦酸盐注射液(99Tc-MDP,商品名云克)联合应用治疗骨转移癌具有协同作用,不仅能治疗骨痛,而且可促进骨转移灶的愈合.我们对46例骨转移癌患者应用153Sm-EDTMP联合99Tc-MDP静脉滴注治疗观察其临床效果.     

^99Tc-MDP缓解乳腺癌芳香化酶抑制剂辅助内分泌治疗后骨关节、肌肉痛的疗效分析

目的应用^99Tc-MDP治疗乳腺癌芳香化酶抑制剂（AI）辅助内分泌治疗后骨关节、肌肉痛，探讨其临床价值。方法收集2003年1月至2007年3月间乳腺癌AI辅助内分泌治疗后骨关节、肌肉痛患者74例，随机分为二组：^99Tc-MDP加服钙尔奇D组（A组）34例，单服钙尔奇D组（B组）40例。比较两组对疼痛的缓解效果。结果骨关节、肌肉痛症状缓解情况：A组总有效率为94．1％，B组为52．5％，两组差异有统计学意义（P〈0．001）。结论^99Tc-MDP使用简便、安全、疗效满意、不良反应少，值得临床推广应用于缓解绝经后乳腺癌AI辅助内分泌治疗后的骨关节、肌肉痛。     

云克治疗多发骨髓瘤的疗效观察

目的 缓解多发骨髓瘤(MM)患者的骨痛,促使骨病灶修复,改善患者的生活质量.方法 28例多发骨髓瘤患者给予云克(99Tc-MDP)治疗,不同疗程下观察疗效.结果 骨痛缓解或消除者21例,总有效率75.0%;87处骨病灶约35处有不同程度范围缩小,病灶数量减少甚至病灶消失,总有效率40.2%.结论 云克治疗多发骨髓瘤有效.     

99m↑Tc-MDP全身骨显像对骨转移瘤的诊断价值

目的探讨99m↑Tc-MDP（99m↑锝-亚甲基二膦酸盐）全身骨显像对骨转移瘤的诊断价值。方法常规采用99 m↑TC-MDP为显像剂,对临床诊断为肺癌、乳腺癌、前列腺癌的230例患者进行核素全身骨显像。结果 230例癌症患者核素骨显像示骨转移者136例,阳性率58.3%,其中肺癌100例,骨转移68例,阳性率68%;乳腺癌100例,骨转移49例,阳性率49%;前列腺癌30例,骨转移19例,阳性率63%。结论肺、乳腺、前列腺癌患者核素骨显像对病程分期、治疗方案选择及预后评估均有重要的临床参考价值。     

鲑鱼降钙素(考克)治疗骨质疏松性骨痛的疗效评价

目的:评价鲑鱼降钙素(商品名考克)对骨质疏松性骨痛的疗效.方法:采用多中心自身对照研究,入选210例骨质疏松及骨量丢失伴有骨痛的患者,给予鲑鱼降钙素50 IU·d-1肌内注射,治疗2周,观察治疗前后骨质疏松性骨痛的变化.结果:199例患者完成治疗,自我评定及医生评分显示不同部位骨痛症状均消失或明显减轻,总有效率均在80%以上(P＜0.005),其中无效者多为合并腰椎间盘突出等其他原因引起的疼痛.有31.43%(66/210)患者出现不良反应,多为恶心、脸红、头晕等,其中5.23%因反应严重或恐惧退出治疗.结论:鲑鱼降钙素治疗骨质疏松性骨痛快速、有效.     

唑来膦酸治疗乳腺癌骨转移的临床观察

目的观察唑来膦酸治疗乳腺癌骨转移的临床疗效和不良反应。方法唑来膦酸4 mg加入0.9%氯化钠液100 m L静脉滴注15 min,每4周给药1次。对患者的骨痛、骨相关事件、生存质量及药物的不良反应进行评估。结果唑来膦酸治疗乳腺癌骨转移患者中重度骨痛、骨转移病灶、生活活动能力的有效率分别为77.4%、69.1%、77.4%;不良反应为发热29例(35.8%),感冒样症状23例(28.4%),低钙血症4例(4.9%),经对症治疗后消失。结论唑来膦酸在治疗乳腺癌骨转移癌性骨痛时起到积极作用,可预防骨相关事件发生,不良反应发生率低。     

中西医结合治疗乳腺癌术后化疗所致骨质疏松的效果分析

目的：探讨中西医结合治疗乳腺癌术后化疗所致骨质疏松的临床效果。方法选取本院2013年7月~2014年1月收治的68例乳腺癌术后化疗所致骨质疏松患者,随机将其分为观察组和对照组,每组34例。观察组给予中西医结合治疗,对照组给予常规西医治疗。比较两组的疗效、治疗前后不同部位骨密度及血钙水平变化情况。结果观察组的总有效率为94.1%,对照组为73.5%,两组比较,差异有统计学意义(P<0.05)。两组治疗1年后的腰椎和股骨颈骨密度均增加,血钙水平上升,与治疗前比较差异有统计学意义,同时两组间差异有统计学意义(P<0.05)。结论中西医结合治疗乳腺癌术后化疗所致骨质疏松的临床效果显著,能够明显改善患者的临床症状,调节其骨代谢,从而起到标本兼治的作用。     

密盖息治疗糖尿病骨质疏松症45例疗效观察

目的 探讨密盖息对糖尿病伴骨质疏松症的疗效。方法 糖尿病伴骨质疏松症患者45例用密盖息50IU隔日肌注3个月，观察治疗前后骨密度、骨代谢指标和骨质疏松性骨痛的变化。结果 治疗后骨密度较治疗前显著升高，甲状旁腺激素、碱性磷酸酶均显著降低，骨病症状减轻或消失，有效率100％。结论 密盖息对糖尿病伴骨质疏松症有较好的治疗效果。     

~(89)锶治疗乳腺癌转移性骨痛临床观察

目的评价89SrC l2对乳腺癌转移性骨痛的临床疗效。方法观察乳腺癌骨转移并伴有不同程度骨痛患者88例,使用89SrC l2静脉注射治疗,观察其镇痛效果、骨转移灶的变化及不良反应等。结果治疗后骨痛减轻或消失75例,总有效率为85.2%;治疗后骨显像有53.4%(47例)骨转移灶代谢减低,治疗前后RO I比值差异具有统计学意义(P<0.05)。未见明显骨髓抑制与肝肾脏功能损伤。结论89Sr对缓解乳腺癌骨转移瘤疼痛有较好疗效,并有一定的治疗作用,副作用小,可重复用药。     

锝[99Tc]亚甲基二膦酸盐注射液和阿仑膦酸钠治疗老年骨质疏松症的临床疗效对比观察

目的:观察锝[99Tc]亚甲基二膦酸盐注射液(云克)和阿仑膦酸钠治疗老年性骨质疏松症患者的临床疗效与安全性。方法:采用随机对照方法,80例骨质疏松患者分为阿仑膦酸钠组(n=40)和云克组(n=40),两组服用足量基础药物钙剂和维生素D同时分别增行阿仑膦酸钠和云克的治疗。疗程结束后,用数字模拟评分法(VAS)及测定骨密度(BMD)评定疗效。结果:阿仑膦酸钠组、云克组两组治疗后腰背痛均有缓解,组间比较云克组止痛起效快,改善最为显著(P<0.05)。阿仑膦酸钠组、云克组两组治疗后BMD均有一定增加,BMD的增加以云克组治疗后6个月最为显著(P<0.05)。结论:对于严重的老年骨质疏松症,云克可在短期内迅速缓解疼痛,增加BMD。阿仑膦酸钠安全性较好,在老年骨质疏松症的长期药物治疗中具有极大的优越性。     

乳腺癌内分泌治疗后骨质疏松的防治体会

目的探讨乳腺癌内分泌辅助治疗后所致骨质疏松的防治措施。方法乳腺癌术后内分泌治疗前后,应用骨密度测定及骨显像检查确诊为骨质疏松患者37例。随机分成两组,均使用钙剂和活性维生素D3,治疗组同时加用唑睐磷酸治疗,观察患者的症状、体征。结果经过治疗两组病情均有缓解,但唑睐磷酸组总有效率明显高于对照组。结论唑睐磷酸能有效改善乳腺癌内分泌治疗后的骨质疏松,治疗不良反应少。     

Screening and management of osteoporosis in breast cancer patients on aromatase inhibitors

OBJECTIVE: Breast cancer patients are at an increased risk of osteoporosis due to age, cancer, chemotherapy, and aromatase inhibitor therapy. This retrospective review determined if patients treated with aromatase inhibitors received appropriate screening and management for osteoporosis. DESIGN: University of Colorado Cancer Center breast cancer patients treated with aromatase inhibitor therapy during July 2005 through July 2006 were studied. Data was collected for each patient from the time of breast cancer diagnosis up to April 2007. The study endpoints included (1) appropriate screening for osteoporosis, (2) incidence of osteoporosis diagnosis, and (3) initiation of appropriate drug therapy for bone loss. Appropriate management was defined as adherence to the 2003 American Society of Clinical Oncology guidelines for bone health issues in women with breast cancer. RESULTS: Of the 54 patients included in this study, 12 (22.2%) had no DEXA scans documented, 22 (40.7%) patients received a baseline DEXA scan and 8 (14.8%) patients received baseline and yearly DEXA scans. During the study timeline, 26 (48%) patients were diagnosed with osteopenia and 4 (7%) patients were diagnosed with osteoporosis. Forty-one (75.9%) patients received calcium and vitamin D therapy. Bisphosphonate therapy was received by less than one-third of the osteopenic patients and three-fourths of the osteoporotic patients. CONCLUSIONS: The majority of patients were not adequately screened which may have falsely lowered the diagnosis of osteoporosis resulting in omission of drug therapy. All high-risk patients should receive calcium and vitamin D therapy and be evaluated for bisphosphonate therapy. Screening and medical management for osteoporosis in breast cancer patients on aromatase inhibitors is an important area for clinical intervention.     

~(99)锝-亚甲基二膦酸盐在类风湿性关节炎中的应用

目的观察99锝-亚甲基二膦酸盐(商品名:云克)对类风湿性关节炎的治疗效果。方法符合诊断标准的患者36例,其中女23例,男13例,平均年龄(53.3±11.4)岁,病程(6.5±2.8)年。给予云克11mg,每日1次静滴,10 d为1个疗程,每月1个疗程,连续3个月。同时辅以类风湿性关节炎的常规内科治疗。结果治疗3个月后,与治疗前比较,明显进步13例,占36.1%,进步17例,占47.2%,改善3例,占8.3%,总有效率为91.67%,经统计学分析,P<0.05。不良反应轻微。结论云克对类风湿性关节炎治疗效果明显,利于病情快速改善、恢复,且使用安全,无明显毒副作用,值得临床推广应用。     

^89SrCl2与^99Tc—MDP联合治疗转移性骨肿瘤疼痛的临床价值

目的：探讨^89SrCl2与云克（^99锝－二甲基二膦酸盐,^99Tc-MDP联合治疗转移性骨肿瘤疼痛的临床价值。方法：68例转移性骨肿瘤患者分别用^89SrCl2单独治疗及与云克联合治疗,观察其疗效。结果：^89SrCl2单独治疗组,止痛总有效率为81．6％转移消失或缩小的总有效率为18．4％,^89SrCl2与云克静脉滴注联合治疗组,止痛总有效率为93．3％,转移灶消失或缩小的总有效率为36．7％。联合治疗组的疗效明显高于单儿治疗组。结论^89SrCl2联合云克对转移性骨肿瘤所致疼痛有明显疗效,且安全无副作用。联合治疗组优于单独治疗组。     

Characterization of Re-188-Sn microparticles used for synovitis treatment

Rhenium-188 labeled tin (Sn) microparticles were developed for pain palliation therapy in the patients suffering from synovitis with acute pain. The rhenium tin microparticles were prepared using stannous chloride and freshly eluted (188)ReO(4)(-) from (188)W/(188)Re generator. The aggregated colloidal particles, packed in a spherical form after boiling for 90-120min were analyzed using electron microscope. The size, surface morphology and stability of microparticles were analyzed by changing temperature and volume conditions. The small colloidal particles clustered and formed spherical microparticles. The 90% of microparticles were in 5-10microm range, after 90min and 120min of boiling. The radiolabeling efficiency was improved to 98% after centrifugation for 10min at 3500rpm. The formulations were stable but the increase in volume had inverse effect on labeling efficiency. No leak was observed from knee area up to 24h with 15-20mCi injection of (188)Re-Sn microparticles. The relief in treated patients, from the pain and inflammation, was observed clinically and by (99m)Tc-MDP perfusion scan.     

99Tc-亚甲基二膦酸盐治疗多发性骨转移癌的临床观察

目的 观察99Tc-亚甲基二膦酸盐(云克,99Tc-MDP)对恶性肿瘤骨转移所至疼痛的治疗效果以及99Tc-MDP对人体Hb、WBC、血小板(PLT)、血清钙及PS评分的影响.方法 选择恶性肿瘤多发骨转移患者78例给予99Tc-MDP治疗.云克200 mg加入0.9%氯化钠注射液500 ml,缓慢静脉滴注2 h,每天1次,连续使用5 d.休息21～28 d,重复第2个周期.每例患者不少于3个周期.结果 99Tc-MDP对Hb、WBC、PLT治疗前后无影响,但对治疗前后的血清钙有明显的影响,可以显著降低高血钙(P＜0.01).对疼痛程度的缓解在治疗前后差异有统计学意义(P＜0.05).对人体力状况PS改善情况在治疗前后变化不明显,差异无统计学意义(P＞0.05).结论 99Tc-MDP治疗骨转移癌有一定的疗效,可以缓解骨转移癌引起的疼痛,对降低骨转移引起的高钙血症有一定作用.使用过程中未发生骨髓功能的抑制,无明显的消化道反应.     

Raloxifene: a review of its use in postmenopausal osteoporosis

Raloxifene is a selective estrogen receptor modulator that partially mimics the effects of estrogens in bone and the cardiovascular system, while functioning as an antiestrogen in endometrial and breast tissue. In randomised placebo-controlled studies involving postmenopausal women or patients with osteoporosis, raloxifene 60 to 150 mg/day was effective in increasing bone mineral density (BMD) over 12- to 36-month periods. At the 60 mg/day recommended dosage, increases of 1.6 to 3.4%, 0.9 to 2.3% and 1.0 to 1.6% were reported in lumbar spine, femoral neck and total hip, respectively, versus < or =0.5% with placebo. Raloxifene 60 or 120 mg/day decreased the risk of vertebral fractures over a 36-month period in postmenopausal patients with osteoporosis. Significant reductions in radiographic fracture risk versus placebo (30 and 50%) occurred regardless of whether patients had existing fractures at baseline. Although raloxifene did not affect the overall incidence of nonvertebral fractures, a reduction in the incidence of ankle fracture was reported in comparison with placebo. In postmenopausal women, raloxifene 60 mg/day significantly reduced serum levels of total and low density lipoprotein cholesterol from baseline, compared with placebo. High density lipoprotein cholesterol and triglyceride levels were unaffected. Raloxifene 60 or 120 mg/day reduced the risk of invasive breast cancer by 76% during a median of 40 months' follow-up in postmenopausal patients with osteoporosis and no history of breast cancer. A relative risk reduction of 90% was reported for estrogen-receptor positive invasive breast cancers; estrogen-receptor negative cancer risk was unaffected by raloxifene. Raloxifene was generally well tolerated in clinical trials at dosages up to 150 mg/day. Adverse events thought to be related to raloxifene treatment were hot flushes and leg cramps. Venous thromboembolism was the only serious adverse event thought to be related to raloxifene treatment and a relative risk of 3.1 compared with placebo treatment was reported in patients with osteoporosis. Vaginal bleeding occurred in < or =6.4% of raloxifene-treated women but was reported by 50 to 88% of those receiving estrogens or hormone replacement therapy (HRT). Raloxifene treatment was not associated with stimulatory effects on the endometrium. CONCLUSIONS: Raloxifene significantly increases BMD in postmenopausal women and reduces vertebral fracture risk in patients with osteoporosis. In clinical trials, raloxifene was generally well tolerated compared with placebo and HRT, although its propensity to cause hot flushes precludes use in women with vasomotor symptoms. In particular, the lack of stimulatory effects on the endometrium and the reduction in invasive breast cancer incidence indicate raloxifene as an attractive alternative to HRT for the management of postmenopausal osteonorosis.     

锝[~99Tc]亚甲基二膦酸盐治疗强直性脊柱炎活动期及远期的疗效

目的:观察锝[~99Tc]亚甲基二膦酸盐(~99Tc-MDP)治疗强直性脊柱炎(AS)活动期及远期的疗效与安全性。方法:78例AS活动期病人分为2组。对照组33例(男性30例,女性3例),用柳氮磺吡啶0．5～0．75g,po,3次·d~(-1),同时适当补充钙及维生素D。治疗组45例(男性43例,女性2例),在对照组用药的基础上联用~99Tc-MDP 5．5 mg,缓慢iv,1次·d~(-1)。每2 wk为一个疗程,疗效欠佳时可连续用2～3个疗程(即连续使用4～6 wk)。2组进行对比观察,观察不良反应、治疗4 wk后的疗效、1 a内疾病复发率和1 a后骨密度变化。结果:治疗组疗效、关节疼痛和肿胀减少倒数、晨僵时间减少例数、ESR、CRP值降低均明显优于对照组(P＜0．01)。不良反应发生率(24％)与对照组(27％)比较差异无显著意义(P＞0．05)。远期疾病复发率7％(3/44)较对照组26％(8/31)低,骨密度值较对照组有显著提高,差异有显著意义(P＜0．01)。结论:~99Tc-MDP治疗AS活动期及远期疗效好、安全。