前列腺癌经雄激素剥夺治疗后骨代谢异常和骨折风险的监测评估  

Monitoring and evaluation of abnormal bone metabolism and fracture risk of prostate cancer after androgen deprivation therapy

作　　者：黄莉[1] 毛丽妮 Huang Li;Mao Lini(Department of Urology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院泌尿外科,长沙410011

出　　处：《国际泌尿系统杂志》2022年第3期462-465,共4页International Journal of Urology and Nephrology

基　　金：湖南省科技厅临床医疗技术创新引导项目 (2018SK52506)。

摘　　要：目的探讨前列腺癌患者经雄激素剥夺治疗(ADT)后的骨代谢异常和骨折风险的监测评估方法。方法选取本院2018年1月至2020年1月行ADT治疗的212例前列腺癌患者为研究对象。比较患者治疗前、治疗6个月及12个月后的骨密度(BMD)[第1腰椎(L1)至第四腰椎(L4)、股骨颈]、骨代谢指标[Ι型胶原羧基端肽β特殊序列(β-CTX)、Ι型前胶原N端前肽(P1NP)和骨钙素(OC)]、骨折风险评估工具(FRAX)、FRAX评分指数[10年内主要部位骨质疏松性骨折风险(PMOF)和10年内髋部骨折风险(PHF)]的变化情况。结果治疗12个月后,患者的L1~4和股骨颈的BMD较治疗前降低,差异均有统计学意义(均P<0.05);治疗12个月后,患者的OC和P1NP水平较治疗前明显下降,而β-CTX较治疗前显著升高,差异均有统计学意义(均P<0.05);治疗12个月后,患者的PMOF和PHF较治疗前明显升高,差异均有统计学意义(均P<0.05)。结论ADT治疗可显著改变前列腺癌患者的骨代谢,导致骨量丢失,增加其骨折风险。BMD、骨代谢指标(β-CTX、P1NP和OC)和FRAX评分可作为监测该类患者经ADT治疗后骨代谢异常和骨折风险的评估工具。Objective To investigate the bone metabolic abnormality and fracture risk in patients with prostate cancer after treated by androgen deprivation therapy(ADT).Methods From January 2018 to January 2020,212 cases with prostate cancer who treated by ADT in our hospital were involved.At time point of pre-treatment,6 months and 12 months after treatment,bone mineral density(BMD)of lumbar spine(L1-4)and femoral neck,bone metabolic markers[beta-C telopeptide(β-CTX),total type I procollagen N-terminal peptide(P1NP),osteocalcin(OC)],and fracture risk assessment tool(FRAX)scores[probability of major osteoporotic fracture in ten years(PMOF),probability of hip fracture in ten years(PHF)]were calculated and analyzed.Results After 12 months of treatment,the BMD of lumbar L1-4 and femoral neck were significantly lower than those of pre-treatment and 6 months after treatment(all P<0.05).Meanwhile,after 12 months of treatment,the level of OC and P1NP were significantly reduced(all P<0.05).Notably,after 12 months of treatment,the PHF and PMOF were significantly higher than those before treatment(all P<0.05).Conclusions ADT treatment can affect bone metabolism and induce bone loss in patients with prostate cancer and thereby increase their osteoporotic fracture risk.BMD,bone metabolic values(β-CTX、P1NP and OC),FRAX scores can be used to monitor and assess the level of bone metabolic abnormality and bone fracture risk.

关 键 词：前列腺肿瘤 雄激素剥夺治疗 骨代谢 骨折 

分 类 号：R737.25[医药卫生—肿瘤]