恶性肿瘤骨转移双膦酸盐类药物相关性颌骨坏死六例临床分析  

Bisphosphonate-related osteonecrosis of the jaw in malignant tumor patients with bone metastases:clinical analysis of six cases

作　　者：辛鹏飞 田之葳 薛国平 刘青梅[1] Xin Pengfei;Tian Zhiwei;Xue Guoping;Liu Qingmei(Department of Stomatology,Shanxi Academy of Medical Sciences,Shanxi Dayi Hospital,Taiyuan 030032,China)

机构地区：[1]山西医学科学院山西大医院口腔科,太原030032

出　　处：《肿瘤研究与临床》2019年第10期670-674,共5页Cancer Research and Clinic

基　　金：山西省卫生健康委员会科研课题(2018017);山西省"1331工程"协同创新中心建设计划;量子光学与光量子器件国家重点实验室(山西大学)开放课题(KF201604)。

摘　　要：目的探讨恶性肿瘤骨转移患者静脉滴注双膦酸盐类药物(BP)后药物相关性颌骨坏死(MRONJ)的临床表现、影像学特征及预防方法。方法回顾性分析2014年1月至2018年4月山西大医院收治的6例发生MRONJ的原发性乳腺癌合并骨转移患者的临床资料及影像学特征。结果6例患者均为女性,中位年龄65.5岁,所有患者均无系统应用激素治疗史、糖尿病史、放疗史、颌骨肿瘤转移史、感染史。平均应用BP的时间为28个月。MRONJ发生在上颌骨2例,下颌骨4例。2例患者有BP治疗中拔牙史。临床表现以颌面部肿痛、牙齿松动、瘘管溢脓、死骨外露等为主。影像学多表现为溶骨、硬化或二者混合性表现,伴或不伴骨膜反应;还有拔牙窝空虚、死骨分离影像等。结论对于使用BP的恶性肿瘤骨转移患者,拔牙是引起MRONJ的高危因素。MRONJ中,下颌骨是最常受累部位,但上颌骨也可发生坏死。患者在使用BP前,建议先到口腔科进行早期筛查及启动牙齿照护计划。Objective To analyze the clinical manifestation,imaging characteristics and prevention of medication-related osteonecrosis of the jaw(MRONJ)after intravenous bisphosphonate(BP)for cancer patients with bone metastases.Methods The clinical data and radiographic findings of 6 primary breast cancer patients with bone metastases diagnosed as MRONJ from January 2014 to April 2018 in Shanxi Dayi Hospital were retrospectively analyzed.Results All 6 patients were female,with the median age of 65.5 years old.All patients had no history of systemic application of hormone therapy,no history of diabetes,no history of radiation therapy,no history of metastasis of the jaw,and no history of infection.The average usage time of BP was 28 months.MRONJ occurred in 2 cases on maxilla and 4 cases on mandible.There were 2 patients with tooth extractions history in BP treatment.Clinical symptoms included maxillofacial pain,loosened teeth,fistula suppuration,and exposed sequestrum.Radiographic findings included osteolysis and bone sclerosis or the mixed manifestation of both,with or without periosteal reaction.In addition,nonhealing tooth sockets and sequestrum separation imaging were also included.Conclusions Tooth extraction is considered as an increased risk for MRONJ in patients with malignant bone metastases after BP therapy.MRONJ is more likely to appear in the mandible,but it can also appear in the maxilla.Early screening and initiation of appropriate dental care are necessary for the patients before using BP therapy.

关 键 词：肿瘤转移 二膦酸盐类 骨骼 药物相关性颌骨坏死 

分 类 号：R73[医药卫生—肿瘤]