唑来膦酸治疗既往用过双膦酸盐实体瘤骨痛疗效观察.docVIP

唑来膦酸治疗既往用过双膦酸盐实体瘤骨痛疗效观察 　 作者：应筱莉 陈旭烽 周月芬 王永辉 【摘要】 目的 评价唑来膦酸治疗既往用过双膦酸盐的实体瘤骨转移患者骨疼痛的缓解效果和安全性。方法 唑来膦酸4mg静脉注射＞15min，1次/４周，治疗既往用过和未用过双膦酸盐的骨转移实体瘤患者，记录疼痛评分，东方协作肿瘤组织(ECOG)体力状态评分和不良反应，每次用药前检测血肌酐水平。结果 疼痛评分较基线下降,ECOG体力状态评分保持稳定。51例患者中，既往用过双膦酸盐28例(54.9%)。发热、乏力和恶心是最常见的不良反应,血清肌酐值无明显升高,在既往用过与未用过双膦酸盐患者间不良反应发生率无统计学意义。结论 既往用过双膦酸盐静脉注射治疗的实体瘤骨转移患者,可安全的给予唑来膦酸治疗。 【关键词】 唑来膦酸 双膦酸盐 骨转移 【Abstract】 Objective To evaluate the safety and pain palliation effects of zoledronic acid in patients with solid tumor who previously received bisphosphonate therapy. Methods Zoledronic acid 4 mg intravenously over 15 minutes every 4 weeks as treatment of bone metastases in patients with solid tumor with and without previous bisphosphonate exposure. Pain score, eastern Cooperative Oncology Group(ECOG) performance status scores and adverse events (AEs) were recorded, and serum creatinine (SCr) levels were measured before each infusion. Results Pain scores decreased from baseline (P＜0.001); ECOG performance status scores remained constant(P＞0.05).Of 51 patients, 28 patients (54.9%) had received prior bisphosphonate therapy. Pyrexia, fatigue, and nausea were the most frequent AEs. SCr level was not increased notably. There was no significant difference observed between the two groups(P＞0.05). Conclusion Solid tumor patients with bone metastases who have previously received intravenous bisphosphonate treatment can be safely converted to zoledronic acid therapy. 【Key words】 Zoledronic acid Bisphosphonate Bone metastase 　　骨是多种实体瘤的转移部位。双膦酸盐能够抑制破骨细胞活性，减少骨重吸收，从而降低骨的相关事件，如骨痛、病理性骨折、脊髓压迫、高钙血症的发病率,从而提高患者的生活质量［１，２］。唑来膦酸是第3代双膦酸盐复合物，与帕米膦酸二钠比较，输注更方便，疗效相当或更有效［１，３，４］。患者接受唑来膦酸4mg静脉注射＞15min，与帕米膦酸二钠90mg静脉注射＞2h比较，肾功能不全的发生率相似的［１，３］。但既往接受过双膦酸盐治疗的患者，再接受唑来膦酸治疗的安全性数据不多。作者对本科自2004年11月至2008年3月，用唑来膦酸对实体瘤骨转移患者进行治疗的51例患者，进行安全性和止痛效果的总结。 1 临床资料 1.1 一般资料 51例患者中男22例，女29例；年龄（54.3±11）岁。均经病理学或细胞学证实的实体瘤，有影像学X线、CT或MRI检查发现至少一处明确的肿瘤相关的骨质破坏，东方协作肿瘤组织（ECOG）评分≤2，血清肌酐（SCr）水平小于正常上限值的1.5倍，校正血钙8.0mg/dl(2.0mmol/l),治疗前重要脏器功能基本正常。既往用过双膦酸盐的患者28例，未用过双膦酸盐的患者23例，具