Sriussadaporn Sutin, Phoojaroenchanachai Meta, Ploybutr Sirirat, Plengvidhya Nattachet, Peerapatdit Thavatchai, Nitiyanant Wannee, Vannasaeng Sathit, Vichayanrat Apichati
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bankgkok, Thailand.
J Med Assoc Thai. 2007 Apr;90(4):663-71.
Examine the clinical and biochemical features including serum intact PTH (iPTH) and plasma PTH-related peptide (PTHrP) levels in patients with malignancy-associated hypercalcemia (MAHC).
Forty-eight patients with histopathological or cytological proven malignancies and MAHC who were admitted to Siriraj Hospital were studied.
The malignancies that caused MAHC were squamous cell carcinoma (45.8%), non-squamous cell solid tumors (31.3 %), and hematological malignancies (22.9%). Most patients (93.8%) had advanced stage malignancies. Corrected serum total calcium (cTCa) levels were 10.8-19.1 mg/dL (13.6 +/- 2.4) and severe hypercalcemia was observed in 17 cases (40.5%). Serum iPTH levels were 0.95-17.1 pg/mL (3.9 +/- 3.6). Most patients had suppressed serum iPTH levels of < 10 pg/mL. Plasma PTHrP levels were 0.2-44.0 pmol/L (3.8 +/- 6.8). There were 27 cases (56.3%) that had humoral hypercalcemia of malignancy (HHM) with plasma PTHrP levels of > 1.5 pmol/L, and 22 cases had squamous cell carcinoma. There was no difference in serum cTCa, phosphorus, alkaline phosphatase, and iPTH levels between patients with HHM and non-HHM. In 48 MAHC patients, serum cTCa correlated to plasma PTHrP (r = 0.35, p = 0.029) and to serum iPTH (r = 0.49, p = 0.003). In 25 patients with HHM, a stronger correlation between serum cTCa and serum iPTH (r = 0.55, p = 0.005) but not between serum cTCa and plasma PTHrP levels (r = 0.41, p = 0.05) was observed. Stepwise multiple regression analyses showed that serum iPTH but not plasma PTHrP levels independently correlated to serum cTCa levels (r = 0.39, p = 0.04).
The clinical manifestations of MAHC observed in the present study were similar to those previously reported. Serum calcium correlated to serum iPTH more strongly than to plasma PTHrP levels. The low but detectable serum iPTH level might play a role in the development of severe MAHC particularly in HHM.
研究恶性肿瘤相关性高钙血症（MAHC）患者的临床和生化特征，包括血清完整甲状旁腺激素（iPTH）和血浆甲状旁腺激素相关肽（PTHrP）水平。
对48例入住诗里拉吉医院、经组织病理学或细胞学证实患有恶性肿瘤及MAHC的患者进行研究。
导致MAHC的恶性肿瘤为鳞状细胞癌（45.8%）、非鳞状细胞实体瘤（31.3%）和血液系统恶性肿瘤（22.9%）。大多数患者（93.8%）处于恶性肿瘤晚期。校正血清总钙（cTCa）水平为10.8 - 19.1mg/dL（13.6±2.4），17例（40.5%）观察到严重高钙血症。血清iPTH水平为0.95 - 17.1pg/mL（3.9±3.6）。大多数患者血清iPTH水平被抑制至<10pg/mL。血浆PTHrP水平为0.2 - 44.0pmol/L（3.8±6.8）。27例（56.3%）患者出现恶性肿瘤体液性高钙血症（HHM），血浆PTHrP水平>1.5pmol/L，其中22例为鳞状细胞癌。HHM患者与非HHM患者在血清cTCa、磷、碱性磷酸酶和iPTH水平上无差异。在48例MAHC患者中，血清cTCa与血浆PTHrP相关（r = 0.35，p = 0.029），与血清iPTH相关（r = 0.49，p = 0.003）。在25例HHM患者中，观察到血清cTCa与血清iPTH之间的相关性更强（r = 0.55，p = 0.005），但血清cTCa与血浆PTHrP水平之间无相关性（r = 0.41，p = 0.05）。逐步多元回归分析显示，血清iPTH而非血浆PTHrP水平与血清cTCa水平独立相关（r = 0.39，p = 0.04）。
本研究中观察到的MAHC临床表现与先前报道的相似。血清钙与血清iPTH的相关性强于与血浆PTHrP水平的相关性。低但可检测到的血清iPTH水平可能在严重MAHC的发生发展中起作用，尤其是在HHM中。
