【摘要】 目的:探讨最大限度雄激素阻断(MAB)治疗对前列腺癌患者骨密度的影响。方法:对40例因前列腺癌行MAB治疗的患者进行调查,治疗时间7～12个月,分别于治疗前后检测血清前列腺特异性抗原(PSA)、睾酮及血钙、血磷、24 h尿钙、尿磷、碱性磷酸酶、甲状旁腺激素、血常规及肝肾功能,双能X线吸收法测定腰椎、股骨颈骨密度,并进行疼痛评分,比较MAB治疗前后各项指标差异。结果:前列腺癌患者治疗前5例(12.5%)腰椎骨量减少,8例(20.0%)腰椎骨质疏松;13例(32.5%)左股骨颈骨量减少,15例(37.5%)左股骨颈骨质疏松。MAB治疗前患者血清PSA为(52.9±69.9)μg/L,睾酮为(18.9±6.5)nmol/L,治疗后PSA为(1.5±1.6)μg/L,睾酮为(1.9±1.3)nmol/L,与治疗前比较均显著下降(P<0.05)。治疗前血钙为(2.5±0.2)mmol/L,血磷为(1.2±0.2)mmol/L,尿钙为(3.1±1.4)mmol/L,尿磷为(11.5±8.1)mmol/L,治疗后血钙为(2.5±0.1)mmol/L,血磷为(1.2±0.1)mmol/L,尿钙为(2.8±1.2)mmol/L,尿磷为(9.9±4.0)mmol/L,两者比较差异均无统计学意义(P>0.05)。治疗前后碱性磷酸酶、甲状旁腺激素、血常规、肝肾功能差异均无统计学意义(P>0.05)。治疗前腰椎和股骨颈骨密度分别为(1.1±0.1)g/cm2和(0.8±0.2)g/cm2,疼痛评分为(0.6±0.2)分,治疗后腰椎和股骨颈骨密度分别为(1.1±0.2)g/cm2和(0.8±0.1)g/cm2,疼痛评分为(0.7±0.1)分,与治疗前比较差异均无统计学意义(P>0.05)。结论:7～12个月MAB治疗对前列腺癌患者骨密度无明显影响,安全有效,但治疗前应注意监测患者骨密度。更多还原

【Abstract】 Objective: To determine the influence of maximal androgen blockade(MAB) on bone mineral density(BMD) in men with prostate cancer.Methods: We enrolled 40 men with prostate cancer treated by MAB for 7 to 12 months.We obtained the laboratory results of PSA,testosterone,serum calcium and phosphorus,24-h urine calcium and phosphorus,alkaline phosphatase,and parathyroid hormone,measured the BMD of the lumbar spine and femoral neck by dual energy X-ray absorptiometry,recorded pain scores,and compared the results before and after the treatment.Results: Before MAB treatment,5(12.5%) of the patients met the BMD criteria of lumbar spine(L2-4) osteopenia,8(20%) lumbar spine(L2-4) osteoporosis,13(32.5%) left femoral neck osteopenia,and 15(37.5%) left femoral neck osteoporosis.The PSA and testosterone levels were decreased from(52.9±69.9) μg/L and(18.9±6.5) nmol/L before MAB to(1.5±1.6) μg/L and(1.9±1.3) nmol/L after it(P<0.05).There were no statistically significant differences before and after MAB in the levels of serum calcium and phosphorus,24-h urine calcium and phosphorus,alkaline phosphatase,and parathyroid hormone(P>0.05),nor in the BMD levels of the lumbar spine([1.1±0.1] vs [1.1±0.2] g/cm2) and femoral neck([0.8±0.2] vs [0.8±0.1] g/cm2),nor in the pain score([0.6±0.2] vs [0.7±0.1],P>0.05).Conclusion: MAB treatment(range from 7 to 12 months) has no significant influence on BMD in men with prostate cancer,but BMD should be measured before MAB.更多还原