术后化疗对妇科恶性肿瘤患者骨密度及骨代谢的影响  

Influence of postoperative chemotherapy on BMD in patients with gynecological malignant tumor

作　　者：孔繁斗[1] 杨丽娜 吴琳 赵春艳[4] 袁宏[5] 

机构地区：[1]大连医科大学附属第一医院妇产科,116011 [2]黑龙江省人民医院妇产科 [3]辽宁抚顺市中心医院妇产科 [4]黑龙江省人民医院临床生化教研室 [5]大连医科大学附属第一医院检验科,116011

出　　处：《中国骨质疏松杂志》2004年第1期61-63,共3页Chinese Journal of Osteoporosis

基　　金：辽宁省教委科研基金资助项目(506346)

摘　　要：目的 观察术后化疗对切除卵巢后的妇科恶性肿瘤患者骨密度及骨代谢的影响,并探讨其可能的影响机理。方法 两组观察对象,肿瘤组20例,术后行PC方案化疗,连续6个疗程,每次间隔4周;对照组与肿瘤组年龄匹配,因良性病变切除卵巢,两组在研究期间均无激素应用。术前及术后6个月采用双能X线骨密度仪对腰椎(L2-L4)及髋部进行骨密度的测定,同时测定血清雌二醇(E2),卵泡刺激素(FSH),黄体生成素(LH),骨钙素(BGP),尿钙/肌酐(ca/Cre),对检测结果进行分析。结果 化疗组腰椎骨密度在治疗后下降22.9％±8.4％,髋骨的骨密度下降12.6％±6.39％,对照组腰椎骨密度下降8.86％±2.87％,髋骨骨密度下降6.12％±2.38％,两组比较差异有显著性P<0.01;E2水平在治疗后下降明显,FSH、LH均在治疗后明显升高,组间无差异;反映骨代谢的指标BGP、Ca/Cre均升高,组间差异无显著性。结论 术后化疗可加重妇科恶性肿瘤患者切除卵巢后的骨质丢失,提示化疗药物(PC)对骨质代谢存在直接的不良影响。Objective To investigate the changes in BMD after postoperative chemotherapy and its possible mechanism. Methods In chemotherapy group, 20 patients who had been treated with cisplatin-cyclophospha-mide (PC) for six cycles at intervals of 4 weeks following surgical treatment were studied. 20 aged-matched women whose ovaries had been removed surgically for other reasons served as controls. None of the patients had received hormonal treatment. The two groups were compared in the changes of BMD of lumbar spine (L2-L4) and femoral neck measured by dual-energy X-ray absorptiometry before study and after 6 months. At the same time , serum levels of estrodiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), serum bone Gla protein (BGP), urine calcium/creatinie (Ca/Cre) were assayed. Results The two groups were compared in changes of BMD over the same period.The mean ( ± standard deviation) BMD of lumbar spine decreased 22.9% ± 8.4% after six cycles of chemotherapy and 8.86% ±2.87% after 6 months in control, .BMD of femoral neck decreased 12.6% ±6.39% and that of control decreased 6.12%± 2.38% . The mean BMD values of lumbar spine and femoral neck in the chemotherapy group were significantly lower than those in control group (P < 0.01). In both groups, levels of E2 declined obviously while FSH and LH rose, reflecting rise of bone metabolic markers (BGP, Ca/Cre) . But there were no significant difference between the two groups. Conclusion Anticancer chemotherapy may directly cause bone loss.

关 键 词：术后化疗 妇科恶性肿瘤 骨密度 骨代谢 骨质疏松 

分 类 号：R737.3[医药卫生—肿瘤] R681[医药卫生—临床医学]