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[癌症与电解质失衡]

[Cancer and electrolytes imbalance].

作者信息

Shibata Hiroyuki

机构信息

Department of Clinical Oncology, Graduate School of Medicine, Akita University.

出版信息

Gan To Kagaku Ryoho. 2010 Jun;37(6):1006-10.

Abstract

The electrolyte imbalance in advanced cancer patients, including hyperkalemia, hypercalcemia and hyponatremia, can be induced by various factors. Hyperkalemia is occasionally induced by chemotherapy for very large malignant tumors, due to tumor lysis syndrome. Hypercalcemia and hyponatremia are often observed in patients with breast cancer, renal cancer, prostate cancer, and the like, as a paraneoplastic syndrome. Some part of hypercalcemia results from osteolysis, but the majority is induced by hormonal factors, such as parathyroid hormone-related protein. One of the paraneoplastic causes of hyponatremia is antidiuretic hormone-producing tumor. These disorders could be morbid or even motile, resulting from encephalopathy or arrhythmia in some cases. However, it should be kept in mind that they could be improved or cured by prompt treatment. Recently, after approval of the molecular targeted drugs for epidermal growth factor receptors, such as cetuximab and panitumumab, the incidence of hypomagnesia with use of these monoclonal antibodies, is relatively frequent. In addition, small molecular targeted drugs, such as m-TORinhibitors and ABL kinase inhibitors, also exert adverse reactions including hypomagnesia and hypophosphatemia. Careful monitoring of the serum concentration of magnesium and phosphate ions, to which little attention was paid previously, is a key issue in these cases.

摘要

晚期癌症患者的电解质失衡,包括高钾血症、高钙血症和低钠血症,可由多种因素诱发。高钾血症偶尔由针对非常大的恶性肿瘤的化疗引起,这是由于肿瘤溶解综合征。高钙血症和低钠血症在乳腺癌、肾癌、前列腺癌等患者中经常作为副肿瘤综合征出现。部分高钙血症是由骨质溶解引起的,但大多数是由激素因素诱发的,如甲状旁腺激素相关蛋白。低钠血症的副肿瘤病因之一是产生抗利尿激素的肿瘤。这些紊乱可能是病态的甚至是致命的,在某些情况下会导致脑病或心律失常。然而,应该记住,通过及时治疗它们可能会得到改善或治愈。最近,在表皮生长因子受体的分子靶向药物如西妥昔单抗和帕尼单抗获批后,使用这些单克隆抗体导致低镁血症的发生率相对较高。此外,小分子靶向药物,如m-TOR抑制剂和ABL激酶抑制剂,也会产生包括低镁血症和低磷血症在内的不良反应。在这些情况下,仔细监测血清镁离子和磷酸根离子浓度(此前很少受到关注)是一个关键问题。

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