本文選題：前列腺癌骨轉(zhuǎn)移 + ~(89)鍶　； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:探討~(89)Sr與唑來膦酸對前列腺癌骨轉(zhuǎn)移治療效果。方法:回顧性分析自南昌大學(xué)第一附屬醫(yī)院2014年01月至2016年6月88例晚期前列腺癌的患者。入院后均完善直腸指診(DRE)、PSA檢測、經(jīng)直腸彩超檢查(TRUS),并經(jīng)直腸前列腺穿刺活檢確診為前列腺癌,骨掃描有單個或多個部位骨轉(zhuǎn)移。88例分成3組(甲組28例,乙組30例,丙組30例):相關(guān)資料包括患者年齡(甲組64.24±7.32,乙組63.82±8.43,丙組63.12±7.43);Gleason評分(≤6分:4/28,5/30,5/30;7分:2/28,3/30,2/30;≥8分:22/28,22/30,23/30);血清TPSA(10ng/ml:1/28,1/30,0/30;10~20ng/ml:4/28,5/30,5/30;20ng/ml:23/28,24/30,25/30)。治療:甲組均以~(89)Sr148 MBq/次(4 mci)靜脈注射,3月一療程;乙組均以4 mg唑來膦酸+0.9%100 ml生理鹽水靜脈滴注,每月1次,3月一療程;88例患者均需采用內(nèi)分泌阻斷雄激素治療。根據(jù)門診隨訪評估患者骨轉(zhuǎn)移病灶數(shù)量、骨痛療效、治療后疼痛指數(shù)、血常規(guī)及肝功能變化、不良反應(yīng)。計量資料不同組間比較采用樣本t檢驗,計數(shù)資料采用X2檢驗,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:(1)骨轉(zhuǎn)移病灶數(shù)量治療有效率:甲組(85.7%)較乙組(60%)高,有統(tǒng)計學(xué)意義(P=0.0290.05);甲組(85.7%)較丙組(50%)高,有統(tǒng)計學(xué)意義(P=0.0040.05);乙組(60%)較丙組(50%)高,無統(tǒng)計學(xué)意義(P=0.4360.05)。(2)骨痛療效緩解率:甲組(92.9%)較乙組(70%)偏高,有統(tǒng)計學(xué)意義(P=0.0260.05);甲組(92.9%)較丙組(66.7%)高,有統(tǒng)計學(xué)意義(P=0.0140.05);乙組70%)較丙組(66.7%)高,無統(tǒng)計學(xué)意義(P=0.7810.05)。(3)治療后疼痛指數(shù):無反應(yīng)率:甲組(3.6%)較乙組(6.7%)低,無統(tǒng)計學(xué)意義(P=0.5950.05);甲組(3.6%)較丙組(13.3%)低,無統(tǒng)計學(xué)意義(P=0.1860.05);乙組(6.7%)較丙組(13.3%)低,無統(tǒng)計學(xué)意義(P=0.3890.05)。中等反應(yīng)率:甲組(17.9%)較乙組(26.7%)低,無統(tǒng)計學(xué)意義(P=0.4210.05);甲組(17.9%)較丙組(53.3%)低,有統(tǒng)計學(xué)意義(P=0.0050.05);乙組(26.7%)較丙組(53.3%)低,有統(tǒng)計學(xué)意義(P=0.0350.05)。反應(yīng)良好率:甲組(32.1%)較乙組(46.7%)低,無統(tǒng)計學(xué)意義(P=0.2940.05);甲組(32.1%)較丙組(26.7%)高,無統(tǒng)計學(xué)意義(P=0.6470.05);乙組(46.7%)較丙組(26.7%)高,無統(tǒng)計學(xué)意義(P=0.1080.05)。反應(yīng)非常好率:甲組(46.4%)較乙組(20%)高,有統(tǒng)計學(xué)意義(P=0.0320.05);甲組(46.4%)較丙組(6.7%)高,有統(tǒng)計學(xué)意義(P=0.0010.05);乙組(20%)較丙組(6.7%)高,無統(tǒng)計學(xué)意義(P=0.1290.05)。(4)肝功能治療前后無明顯變化,~(89)Sr常見的不良反應(yīng)是骨髓抑制(50%),以輕度骨髓抑制為主。唑來膦酸常見副作用是消化系統(tǒng)癥狀(13.3%)。血液系統(tǒng)不良事件:1級:甲組(28.6%)較乙組(6.7%)高,有統(tǒng)計學(xué)意義(P=0.0270.05);甲組(46.4%)較丙組(3.3%)高,有統(tǒng)計學(xué)意義(P=0.0080.05);乙組(6.7%)較丙組(3.3%)高,無統(tǒng)計學(xué)意義(P=0.5540.05)。2級:甲組(14.3%)較乙組(3.3%)高,無統(tǒng)計學(xué)意義(P=0.1380.05);甲組(46.4%)較丙組(0%)高,有統(tǒng)計學(xué)意義(P=0.0320.05);乙組(3.3%)較丙組(0%)高,無統(tǒng)計學(xué)意義(P=0.3130.05)。3級:甲組(7.14%)較乙組(0%)高,無統(tǒng)計學(xué)意義(P=0.1360.05);甲組(7.14%)較丙組(0%)高,無統(tǒng)計學(xué)意義(P=0.1360.05);乙組(0%)與丙組(0%)無法比較。結(jié)論:(1)前列腺癌骨轉(zhuǎn)移病灶數(shù)量減少:~(89)Sr聯(lián)合內(nèi)分泌療效明顯優(yōu)于唑來膦酸聯(lián)合內(nèi)分泌、單獨內(nèi)分泌療效。(2)骨痛療效緩解率:~(89)Sr聯(lián)合內(nèi)分泌療效明顯優(yōu)于唑來膦酸聯(lián)合內(nèi)分泌、單獨內(nèi)分泌療效。(3)治療后疼痛指數(shù):反應(yīng)非常好率,~(89)Sr聯(lián)合內(nèi)分泌療效明顯優(yōu)于唑來膦酸聯(lián)合內(nèi)分泌、單獨內(nèi)分泌療效;無反應(yīng)率、中等反應(yīng)率、反應(yīng)良好率無統(tǒng)計學(xué)差異。(4)血液系統(tǒng)不良事件1級:~(89)Sr較唑來膦酸多見;~(89)Sr不良反應(yīng)比唑來膦酸少見。肝功能治療前后無明顯變化。
[Abstract]:Objective: To investigate the effect of ~ (89) Sr and zoledronic acid on bone metastasis of prostate cancer. Methods: retrospective analysis of 88 patients with advanced prostate cancer from 01 months to June 2016 2014 from the First Affiliated Hospital of Nanchang University. After admission, the rectal finger diagnosis (DRE), PSA test, direct Chang Caichao examination (TRUS), and transrectal prostate biopsy were confirmed. For prostate cancer, bone scan was divided into 3 groups of.88 cases (28 cases in group A, 30 in group B, 30 in group C). The related data included patients' age (64.24 + 7.32, 63.82 + 8.43 and 63.12 + 7.43 in C); Gleason score (< < < < 4/28,5/ > > > 2/28,3/30,2/30; < < < < 64.24 > > 22/28,22/30,23/30); and serum TPSA (10ng/m). L:1/28,1/30,0/30; 10~20ng/ml:4/28,5/30,5/30; 20ng/ml:23/28,24/30,25/30). Group A was treated with ~ (89) Sr148 MBq/ (4 MCI) intravenous injection, a course of treatment in March; group B with 4 mg zoledronic acid +0.9%100 ml normal saline intravenous drip, 1 times a month, and a course of treatment; 88 patients all need endocrine blocking androgens. The number of bone metastases, the effect of bone pain, the pain index after treatment, the change of blood routine and liver function, the adverse reaction. The t test was used in different groups. The count data were tested by X2 test, and the difference of P0.05 was statistically significant. (1) the effective rate of the number of bone metastases was: (85.7%) compared with group B (60%) High, statistically significant (P=0.0290.05); group A (85.7%) was higher than group C (50%) and was statistically significant (P=0.0040.05); group B (60%) was higher than group C (50%) and had no statistical significance (P=0.4360.05). (2) the remission rate of bone pain: (92.9%) was higher than group B (70%), statistically significant (P=0.0260.05); group A (92.9%) was higher than group C (66.7%) and statistically significant P=0.0140.05, group B 70%) was higher than group C (66.7%), no statistical significance (P=0.7810.05). (3) the pain index after treatment: no response rate: group A (3.6%) was lower than group B (6.7%), no statistical significance (P=0.5950.05); group A (3.6%) was lower than group C (13.3%), no statistical significance (P=0.1860.05); group B (6.7%) was lower than group C (13.3%), and was not statistically significant (P=0. 3890.05) medium reaction rate: group A (17.9%) was lower than group B (26.7%) and had no statistical significance (P=0.4210.05); group A (17.9%) was lower than group C (53.3%), and was statistically significant (P=0.0050.05); group B (26.7%) was lower than group C (53.3%), and had statistical significance (P=0.0350.05). The rate of good reaction (32.1%) was lower than group B (46.7%), and no statistical significance (P=0.2940.05 Group A (32.1%) was higher than group C (26.7%) and had no statistical significance (P=0.6470.05); group B (46.7%) was higher than group C (26.7%) and had no statistical significance (P=0.1080.05). The rate of reaction was very good: group A (46.4%) was higher than group B (20%) and was statistically significant (P= 0.0320.05); group A (46.4%) was higher than group C (6.7%) (P=0.0010.05); group B (20%) was compared with group C (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%) (20%). 6.7%) high, no statistical significance (P=0.1290.05). (4) there was no significant change of liver function before and after treatment. The common adverse reactions of ~ (89) Sr were myelosuppression (50%) and mild myelosuppression. The common side effects of zoledronic acid were digestive system symptoms (13.3%). The adverse events of the blood system: Grade 1: group A (28.6%) was higher than group B (6.7%), and had statistical significance (P=0. 270.05); group A (46.4%) was higher than group C (3.3%) (P=0.0080.05); group B (6.7%) was higher than group C (3.3%) and had no statistical significance (P=0.5540.05).2: group A (14.3%) was higher than group B (3.3%), no statistical significance (P=0.1380.05); group A (46.4%) was higher than group C (0%), and was statistically significant (P=0.0320.05); group B (3.3%) was higher than group C (0%), and no Statistical significance (P=0.3130.05).3: group A (7.14%) was higher than group B (0%), no statistical significance (P=0.1360.05); group A (7.14%) was higher than group C (0%), no statistical significance (P=0.1360.05); group B (0%) and C (0%) could not be compared. Conclusion: (1) the number of bone metastases in prostate cancer is reduced: ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid Endocrine, independent endocrine curative effect. (2) the curative effect of bone pain relief: ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid combined endocrine, independent endocrine effect. (3) after treatment pain index: the reaction is very good rate, ~ (89) Sr combined endocrine effect is obviously better than zoledronic acid combined endocrinology, individual endocrine effect; no reaction rate, There was no significant difference in the rate of moderate reaction. (4) 1 levels of adverse events in the blood system: ~ (89) Sr was more common than zoledronic acid; ~ (89) Sr adverse reactions were less than zoledronic acid. There was no significant change in liver function treatment.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.25

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