乳腺癌内分泌相关骨质疏松的机制及其防治的前景探讨  

Mechanism of endocrine related osteoporosis in breast cancer and its prospect of prevention and treatment

作　　者：郭鱼波 郭林涛 沈静[1] 郝艳方 裴晓华 GUO Yubo;GUO Lintao;SHEN Jing;HAO Yanfang;PEI Xiaohua(Beijing University of Chinese Medicine,Beijing 100029;Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第三附属医院,北京100029

出　　处：《中国骨质疏松杂志》2018年第10期1375-1383,共9页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金委地区科学基金项目(81560775);北京中医药大学2018年自主选题在读研究生项目(2018-JYBZZ-XS235)

摘　　要：内分泌相关骨质疏松是乳腺癌内分泌治疗引起的严重不良反应,急需引起人们的关注。内分泌治疗可以使绝经前和绝经后乳腺癌患者的肿瘤降期,有效提高保乳率。然而大量临床研究表明,乳腺癌内分泌治疗会引起继发性骨质疏松,联合双膦酸盐治疗后可降低乳腺癌患者骨质疏松的发病率,但是不可长期服用。进一步研究发现,内分泌相关骨质疏松的发病机制与雌激素、雌激素受体、成骨细胞与破骨细胞、维生素D及甲状旁腺素有关。中医药多以补益肾肝、调理脾胃、活血化瘀、抗肿瘤为主,安全有效。笔者着重分析了乳腺癌内分泌治疗易导致骨质疏松及现代医学的发病机制,中医病因病机及中医药治疗乳腺癌内分泌相关骨质疏松的研究进展及发展前景,旨在有助于中医药防治乳腺癌内分泌相关骨质疏松机制的深入研究,及新型靶点药物的研发,从而更好地服务于临床和科研。Endocrine-related osteoporosis is a serious adverse effect caused by endocrine therapy of breast cancer,which needs urgent attention.Endocrine therapy can reduce the tumors in premenopausal and postmenopausal women with breast cancer,and effectively increase the rate of breast-conservation.However,a large number of clinical studies have shown that endocrine treatment of breast cancer could cause secondary osteoporosis.Combining endocrine treatment with bisphosphonate can significantly reduce the incidence of osteoporosis in patients with breast cancer.Further studies found that the pathogenesis of endocrine-related osteoporosis is related to estrogen,estrogen receptors,osteoblasts and osteoclasts,vitamin D and parathyroid hormone(PTH).In view of the side effects of bisphosphonates,the overall syndrome differentiation of traditional Chinese medicine is particularly important.Traditional Chinese medicine is mainly used to replenish kidney and liver,regulate spleen and stomach,promote blood circulation,resolve phlegm,and anti-tumor.It is safe and effective.This article focuses on analyzing osteoporosis caused by endocrine therapy of breast cancer and its pathogenesis in modern medicine,TCM etiology and pathogenesis,and the research progress and development prospects of Chinese medicine in the treatment of endocrine-related osteoporosis in breast cancer.We expect this article will be of help for the in-depth study of the mechanism in preventing and treating endocrine-related osteoporosis in breast cancer using Chinese medicine and the research of new target drugs,with the aim of serving clinical and scientific research better.

关 键 词：乳腺肿瘤 内分泌治疗 骨质疏松 中医中药 

分 类 号：R737.9[医药卫生—肿瘤]