乳腺癌综合治疗课案.ppt

In a study of women ≥ 65 years of age, rate of hip fracture was found not only to depend on bone mineral density (BMD), but also on additional risk factors Overall, patients with ≥ 5 risk factors had an approximate 10-fold increase in risk of hip fracture, and this increase was independent of BMD This study included white women ≥ 65 years of age (N = 9,516) without previous hip fracture Participants were evaluated every 4 months for an average of 4.1 years to determine frequency of hip fracture Risk factors that were significantly associated with increased hip fracture included (slide shows more significant risk factors) Age ≥ 80 years Maternal history of hip fracture Any fracture since age 50 (except hip) Fair, poor, or very poor health Previous hyperthyroidism Anticonvulsant therapy Current long-acting benzodiazepine therapy Current weight less than weight at age 25 Height at age 25 ≥ 168 cm Caffeine intake more than equivalent of 2 cups of coffee per day On feet ≤ 4 hours a day No walking for exercise; inability to rise from chair without using arms Lowest quartile of depth perception Lowest quartile of contrast sensitivity Pulse rate 80 per minute * 降低子宫内膜问题的发生率 降低血栓栓塞的发生率 更少泌尿生殖系统症状 骨保护作用 心血管保护作用 子宫内膜增厚（子宫内膜癌） 血栓栓塞性疾病 潮热等内分泌症状 泌尿生殖系统症状 中风 骨质丢失 关节肌肉痛 潮热等内分泌症状 对心血管系统的影响？ 对血脂的影响？ TAM AI AI：芳香化酶抑制剂；TAM：他莫昔芬 AI与TAM安全特征不同 控制绝经症状的选择 目前治疗绝经症状的药物 雌激素 非雌激素类的植物药 黑升麻提取物（丽芙敏） X 雌激素水平下降对腰椎BMD的影响 时间，年 正常 绝经 骨密度最高 青春期 均数 腰椎 BMD，g/m2 骨折风险 骨密度降低 1.2 1.1 1.0 0.9 0.8 0 0 10 20 30 40 50 60 70 Adapted from Reid D, et al. Cancer Treat Rev. 2008;34(Suppl 1):S3-18. 标准差 AIs治疗增加骨折风险 骨折发生率, % 11 7.7 5.7 4.0 5.3 4.6 7.0 5.0 P .0001 P .001 0 2 4 6 8 10 12 P = .03 P = .25 他莫昔芬 来曲唑 阿那曲唑 安慰剂 依西美坦 ATAC2 6,186 68 个月 IES3 4,724 58个月 BIG 1-9848,010 26 个月 MA.1755,187 30 个月 患者数，N 中位随访时间 2.3 2.7 P = NS TEAM69,670 33个月 1.Adapted from Hadji P. US Oncological Disease. 2007;1:18-21. Available at: /files/article