Lee M, Chubachi A, Imai H, Kodama T, Morita K, Kuroki J, Nakamoto Y, Miura A B, Saito M, Watanuki T
Akita University School of Medicine, Third Department of Internal Medicine.
Rinsho Ketsueki. 1991 Dec;32(12):1527-32.
The clinical studies about the electrolyte abnormality (EA) in patients with malignant lymphoma (ML) are rarely reported. We analyzed the EA and renal insufficiency in 123 patients with ML between June. 1976 and Jan. 1989; 8 patients with Hodgkin's disease, and 115 patients with non-Hodgkin's lymphoma (NHL). Before treatment, the incidence of the EA was 24.2% and hypercalcemia, hypocalcemia, and hyperkalemia were predominant. After treatment it became to 74.7% and the number of hyponatremia and hypokalemia increased. The incidence of proteinuria and renal insufficiency (serum creatinine above 1.5 mg/dl), were 7.3% and 2.4% before treatment, and became to 26.8% and 26.8% after treatment, respectively. There was a significant difference between two groups with and without the EA before treatment as for serum lactate dehydrogenase (LDH) levels (p less than 0.01), clinical stages (p less than 0.05) and the incidence of bone marrow involvement (p less than 0.01). In 34 autopsied cases, 3 cases showed massive renal involvement and about a half of cases showed various renal changes. The EA before treatment was caused by extrarenal factors, because the incidence of proteinuria and renal insufficiency were almost same to healthy controls. And renal factors play an important role on the E.A after treatment. Above results suggest that the EA before treatment indicates the progress of malignant lymphoma and the EA after treatment means not only the progress of the disease but also therapy-related renal damages.
关于恶性淋巴瘤（ML）患者电解质异常（EA）的临床研究鲜有报道。我们分析了1976年6月至1989年1月期间123例ML患者的EA及肾功能不全情况；其中8例为霍奇金病患者，115例为非霍奇金淋巴瘤（NHL）患者。治疗前，EA的发生率为24.2%，以高钙血症、低钙血症和高钾血症为主。治疗后，发生率升至74.7%，低钠血症和低钾血症的数量增加。蛋白尿和肾功能不全（血清肌酐高于1.5mg/dl）的发生率在治疗前分别为7.3%和2.4%，治疗后分别升至26.8%和26.8%。治疗前有EA和无EA的两组患者在血清乳酸脱氢酶（LDH）水平（p<0.01）、临床分期（p<0.05）及骨髓受累发生率（p<0.01）方面存在显著差异。在34例尸检病例中，3例显示有大量肾脏受累，约一半病例显示有各种肾脏改变。治疗前的EA是由肾外因素引起的，因为蛋白尿和肾功能不全的发生率与健康对照者几乎相同。而治疗后的EA中肾脏因素起重要作用。上述结果表明，治疗前的EA提示恶性淋巴瘤的进展，治疗后的EA不仅意味着疾病的进展，还意味着与治疗相关的肾脏损害。
