罗军 彭积院 潘铃娟

【摘要】 目的：探討亮丙瑞林对雌激素受体（ER）阳性绝经前乳腺癌化疗患者卵巢功能及骨密度（BMD）的影响。方法：选取2020年1月—2022年8月丰城市人民医院收治的82例ER阳性绝经前乳腺癌患者的病历资料进行回顾性分析，根据治疗方式分为化疗组（n=41）和亮丙瑞林组（n=41）。化疗组患者予以AC-T辅助化疗，亮丙瑞林组在化疗组的基础上联合亮丙瑞林治疗。比较两组患者疗效、卵巢功能、BMD及月经情况。结果：亮丙瑞林组的总有效率高于化疗组（P<0.05）。治疗后，两组血清雌二醇（E2）水平均明显降低，血清促黄体生成素（LH）、卵泡刺激素（FSH）水平均明显升高（P<0.05）；亮丙瑞林组患者的血清LH、FSH水平均明显高于化疗组，血清E2水平明显低于化疗组（P<0.05）。治疗后，两组左髋部、腰椎的BMD水平均明显降低（P<0.05）；两组比较差异均无统计学意义（P>0.05）。亮丙瑞林组的闭经时间、月经恢复正常时间均较化疗组短，月经复潮率较化疗组高（P<0.05）。结论：亮丙瑞林可保护ER阳性绝经前乳腺癌化疗患者卵巢功能，可有效提高疗效，但可能会导致患者BMD下降，需要在治疗期间注意监测BMD变化，降低骨质疏松发生风险。

【关键词】 雌激素受体阳性 绝经前乳腺癌 化疗 亮丙瑞林 卵巢功能 骨密度

Effects of Leuprorelin on Ovarian Function and Bone Mineral Density in ER Positive Premenopausal Breast Cancer Patients Undergoing Chemotherapy/LUO Jun， PENG Jiyuan， PAN Lingjuan. //Medical Innovation of China， 2024， 21（07）： -126

[Abstract] Objective： To investigate the effect of Leuprorelin on ovarian function and bone mineral density （BMD） of estrogen receptor （ER） positive premenopausal breast cancer patients undergoing chemotherapy. Method： The medical records of 82 ER positive premenopausal breast cancer patients admitted to Fengcheng People's Hospital from January 2020 to August 2022 were retrospectively analyzed， and they were divided into chemotherapy group （n=41） and Leuprorelin group （n=41） according to treatment methods. Patients in chemotherapy group were treated with AC-T adjuvant chemotherapy， and Leuprorelin group was treated with Leuprorelin on the basis of chemotherapy group. The curative effect， ovarian function， BMD and menstruation were compared between the two groups. Result： The total effective rate of Leuprorelin group was higher than that of chemotherapy group （P<0.05）. After treatment， serum estradiol （E2） levels in both groups were significantly decreased， and serum luteinizing hormone （LH） and follicle stimulating hormone （FSH） levels were significantly increased （P<0.05）; serum LH and FSH levels in Leuprorelin group were significantly higher than those in chemotherapy group， and serum E2 level was significantly lower than that in chemotherapy group （P<0.05）. After treatment， BMD levels of left hip and lumbar vertebrae were significantly decreased in both groups （P<0.05）; there were no significant differences between the two groups （P>0.05）. The amenorrhea time and menstrual normalcy time of Leuprorelin group were shorter than those of chemotherapy group， and the rate of menstrual rehydration was higher than that of chemotherapy group （P<0.05）. Conclusion： Leuprorelin can protect the ovarian function in patients with ER positive premenopausal breast cancer undergoing chemotherapy， which can effectively improve the therapeutic effect， but may lead to the decrease of BMD in patients， it is necessary to pay attention to the change of BMD during treatment to reduce the risk of osteoporosis.

[Key words] Estrogen receptor positive Premenopausal breast cancer Chemotherapy Leuprorelin Ovarian function Bone minernal density

First-author's address： General Surgery Department Ⅱ， Fengcheng People's Hospital， Fengcheng 331100， China

doi：10.3969/j.issn.1674-4985.2024.07.029

乳腺癌是常見的妇科恶性疾病，具有较高的发病率及死亡率，如不及时治疗，将严重威胁女性的生命健康，乳腺癌的常规治疗方式是以手术切除辅助化疗为主[1]。雌激素受体（estrogen receptor，ER）对雌激素具有较强的亲和性，可与雌激素结合，从而促进细胞增殖，多种研究表明，ER与乳腺癌的进展密切相关[2]。有研究显示，一半以上的乳腺癌患者在绝经前发病，且相当大一部分ER阳性患者经过手术治疗后化疗辅助效果不佳，进而导致卵巢早衰，进入绝经状态，此时使用化疗药物治疗绝经后激素受体阳性乳腺癌患者效果不佳[3-4]。因此，需要找到治疗绝经前ER阳性患者科学有效的治疗方案。卵巢功能抑制是ER阳性绝经前乳腺癌患者的主要治疗方式之一，亮丙瑞林是常见的卵巢功能抑制药物，具有效果稳定、对患者损伤小的优势[5]。……