帕米膦酸二钠相关下颌骨坏死

1例60岁男性2型糖尿病患者,因小细胞肺癌骨转移,给予帕米膦酸二钠60mg,溶于0.9%氯化钠注射液500ml,于4～5h静脉泵入,1～3个月给药1次,17个月内共给药10次,之后因头颅转移行头部放射治疗。放射治疗前2d开始服用泼尼松10mg,3次/d,连用37d。放射治疗结束后,患者再次接受帕米膦酸二钠治疗,剂量和给药途径同前,1年内共给药5次。在这1年间患者经常出现牙龈肿痛、溢脓,口腔科诊断为下颌骨坏死。考虑下颌骨坏死可能与帕米膦酸二钠有关,或与双膦酸盐和放射治疗两者有关。

Osteonecrosis of the jaw associated with pamidronate disodium

A 60-year-old man with type 2 diabetes mellitus received an IV infusion of pamidronate disodium 60 mg dissolved in 0. 9% sodium chloride 500 ml, which was given within 4-5 hours via an infusion pump, for bone metastasis of small cell lung cancer. The dosing interval was once every 1-3 months. He received pamidronate 10 times within 17 months. Subsequently, the patient received head radiotherapy for brain metastasis. Two days before radiotherapy, he was given prednisone 10 mg thrice daily for 37 days. After radiotherapy completion, the patient was retreated with pamidronate disodium therapy, and the dosage and administration were the same as the previous regimen. He received pamidronate 5 times within one year. During this year, the patient experienced recurrent gingival swelling, pains and pyorrhea. Osteonecrosis of the jaw （ONJ） was diagnosed by dentists. ONJ was considered to be associated with pamidronate disodium, or both bisphosphonates and radiotherapy.