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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。
Objective: To investigate the effect of maximal androgen blockade (MAB) on bone mineral density in patients with prostate cancer. Methods: Forty patients with MAB treated for prostate cancer were investigated. The treatment time ranged from 7 to 12 months. Serum PSA, serum testosterone, serum calcium, serum phosphorus, 24 h urinary calcium , Urinary phosphorus, alkaline phosphatase, parathyroid hormone, blood and liver and kidney function, bone mineral density measurement of lumbar spine and femoral neck by dual-energy X-ray absorptiometry. The pain score was compared. The differences of various indexes before and after MAB treatment were compared. Results: The lumbar vertebral osteoporosis was reduced in the first five cases (12.5%) of the prostate cancer patients and in the osteoporosis of the lumbar vertebrae in eight cases (20.0%). The left femoral neck mass was decreased in 13 cases (32.5%) and left femur in 15 cases (37.5% Neck osteoporosis. The serum PSA level before MAB treatment was (52.9 ± 69.9) μg / L and that of testosterone was (18.9 ± 6.5) nmol / L, and the PSA level was (1.5 ± 1.6) μg / L and , Compared with before treatment were significantly decreased (P <0.05). Pretreatment serum calcium was (2.5 ± 0.2) mmol / L, serum phosphorus was (1.2 ± 0.2) mmol / L, urinary calcium was (3.1 ± 1.4) mmol / L and urinary phosphorus was (11.5 ± 8.1) After treatment, serum calcium was (2.5 ± 0.1) mmol / L, serum phosphorus was (1.2 ± 0.1) mmol / L, urinary calcium was (2.8 ± 1.2) mmol / L and urinary phosphate was (9.9 ± 4.0) There was no significant difference between the two (P> 0.05). Before and after treatment, alkaline phosphatase, parathyroid hormone, blood, liver and kidney function differences were not statistically significant (P> 0.05). The BMD of lumbar spine and femoral neck were (1.1 ± 0.1) g / cm2 and (0.8 ± 0.2) g / cm2 respectively, and the pain score was 0.6 ± 0.2. The BMD of lumbar and femoral neck after treatment was ± 0.2) g / cm 2 and (0.8 ± 0.1) g / cm 2 respectively, and the pain score was (0.7 ± 0.1) points. There was no significant difference between before and after treatment (P> 0.05). Conclusion: MAB treatment for 7-12 months has no obvious effect on bone mineral density in patients with prostate cancer, which is safe and effective. However, it is necessary to monitor the bone mineral density before treatment.