Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
Department of Surgery, Miura City Hospital, 4-33 Koyo-cho, Miura, Japan.
Gastric Cancer. 2019 Jan;22(1):237-243. doi: 10.1007/s10120-018-0835-9. Epub 2018 May 10.
Several retrospective studies have shown that bone disorders occur after gastric cancer surgery. This study was designed to prospectively evaluate the changes in bone metabolism after gastrectomy for gastric cancer.
We prospectively enrolled 39 men with early gastric cancer who underwent gastrectomy. We excluded women to avoid the effects of menopause. We employed dual energy X-ray absorptiometry (DEXA) to measure bone mineral density (BMD) of the lumbar spine. DEXA was performed before and 1 and 2 years after surgery. The serum levels of alkaline phosphatase (ALP), 1,25-dihydroxy vitamin D [1,25(OH)VD], 25-hydroxy vitamin D [25(OH)VD], and estradiol were measured before surgery and every 3 months until 2 years after surgery.
DEXA revealed that BMD significantly decreased by 0.036 ± 0.033 g/cm 12 months after gastrectomy (P < 0.001) and by 0.046 ± 0.040 g/cm 24 months after gastrectomy (P < 0.001). The serum ALP level significantly increased by 38.31 ± 103.8 IU/L 24 months after surgery (P = 0.013). The serum 25(OH)VD level significantly decreased by 4.88 ± 6.42 ng/ml 24 months after surgery (P < 0.001), whereas the serum 1,25(OH)VD levels were consistently in the normal range. The serum estradiol level significantly increased by 2.94 ± 7.49 pg/ml 12 months after gastrectomy (P = 0.035). A lower preoperative body mass index (BMI) significantly correlated with the reduction in BMD 12 months after surgery; the correlation coefficient was 0.37 (P = 0.025).
This study showed that a significant decrease in BMD was observed for up to 24 months after gastrectomy, not only 12 months.
几项回顾性研究表明，胃癌手术后会发生骨骼疾病。本研究旨在前瞻性评估胃癌胃切除术后骨代谢的变化。
我们前瞻性纳入 39 名男性早期胃癌患者行胃切除术。我们排除女性以避免绝经的影响。我们采用双能 X 线吸收法（DEXA）测量腰椎骨矿物质密度（BMD）。DEXA 在术前和术后 1 年及 2 年进行。术前及术后每 3 个月检测血清碱性磷酸酶（ALP）、1,25-二羟维生素 D [1,25(OH)VD]、25-羟维生素 D [25(OH)VD]和雌二醇水平。
DEXA 显示，术后 12 个月 BMD 显著下降 0.036±0.033 g/cm²（P<0.001），术后 24 个月 BMD 进一步下降 0.046±0.040 g/cm²（P<0.001）。术后 24 个月时，血清 ALP 水平显著升高 38.31±103.8 IU/L（P=0.013）。术后 24 个月时，血清 25(OH)VD 水平显著下降 4.88±6.42 ng/ml（P<0.001），而血清 1,25(OH)VD 水平始终在正常范围内。术后 12 个月时，血清雌二醇水平显著升高 2.94±7.49 pg/ml（P=0.035）。术前较低的体重指数（BMI）与术后 12 个月时 BMD 的下降显著相关，相关系数为 0.37（P=0.025）。
本研究表明，胃癌胃切除术后 BMD 至少在 24 个月内显著下降，而不仅仅是 12 个月。
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