Gallacher S J
Medical Unit B, Southern General Hospital, Glasgow, Scotland.
Pharmacoeconomics. 1996 Jan;9(1):39-50. doi: 10.2165/00019053-199609010-00005.
Hypercalcaemia associated with cancer is seen not infrequently in hospital practice and can be a source of considerable morbidity. Over the past decade, our understanding of the pathogenesis of this syndrome has advanced, allowing improved treatment protocols. Because one of the principal abnormalities relates to an increase in bone resorption, antiresorptive agents such as calcitonin and the bisphosphonates have been shown to be of value. In the medium to longer term, the bisphosphonates -particularly pamidronic acid[pamidronate;aminohydroxypropylidene bisphosphonate (APD)] and clodronic acid [clodronate; dichloromethyl bisphosphonate (Cl2MDP)]¿ appear to be more efficacious in terms of their calcium-lowering effect than calcitonin, and also appear to be associated with fewer adverse effects than most other agents. However, the importance of energetic re-expansion of the extracellular space with 0.9% sodium chloride before bisphosphonate therapy is extremely important. Cancer-associated hypercalcaemia, especially with squamous cancer, is often associated with the production of parathyroid hormone-related protein (PTHrP). Where this is the case, it usually reflects the presence of more advanced disease with shortened life expectancy, and poorer response to calcium-lowering therapy. Multiple treatments with larger doses of bisphosphonate may be required for these patients.
癌症相关的高钙血症在医院临床实践中并不少见，且可能是相当大的发病原因。在过去十年中，我们对该综合征发病机制的理解有所进展，从而改进了治疗方案。由于主要异常之一与骨吸收增加有关，降钙素和双膦酸盐等抗吸收剂已显示出具有价值。从中长期来看，双膦酸盐——特别是帕米膦酸[帕米膦酸盐；氨基羟丙基亚乙基双膦酸盐（APD）]和氯膦酸[氯膦酸盐；二氯甲基双膦酸盐（Cl2MDP）]——在降低血钙方面似乎比降钙素更有效，而且与大多数其他药物相比，不良反应似乎也更少。然而，在双膦酸盐治疗前用0.9%氯化钠积极扩充细胞外液极为重要。癌症相关的高钙血症，尤其是鳞状细胞癌相关的，常与甲状旁腺激素相关蛋白（PTHrP）的产生有关。在这种情况下，通常反映疾病进展更严重，预期寿命缩短，对降钙治疗反应较差。这些患者可能需要多次使用大剂量双膦酸盐进行治疗。
