Gallacher S J, Ralston S H, Dryburgh F J, Logue F C, Allam B F, Boyce B F, Boyle I T
University Department of Medicine, Glasgow Royal Infirmary, UK.
Postgrad Med J. 1990 Nov;66(781):918-22. doi: 10.1136/pgmj.66.781.918.
Immobilization-related hypercalcaemia is an uncommon but important condition being associated not infrequently with both urolithiasis and osteoporosis. In this study 5 patients who had been immobilized for a mean of 3 months and had a mean adjusted serum calcium of 3.15 mmol/l were treated with doses of intravenous pamidronate ranging between 10 mg and 45 mg. All patients became normocalcaemic by day 3. Patients 1-3 mobilized shortly after treatment and remained normocalcaemic. In those patients who continued to be immobile hypercalcaemia recurred after an interval of several weeks. Retreatment with pamidronate again resulted in normocalcaemia. No side effects were noted with treatment. All of the patients studied had increased rates of bone resorption as shown by elevated urinary hydroxyproline/creatinine ratios (median:range) of 0.101:0.045-0.180 (normal less than 0.033) and elevated calcium/creatinine ratios of 2.50:0.69-3.63 (normal less than 0.50). None of the patients in this study had any of the usual risk factors for developing immobilization-related hypercalcaemia though all 5 patients had problems with significant sepsis which we postulate may have lead to cytokine release which in turn contributed to the development of hypercalcaemia. We conclude that pamidronate (at doses as low as 10 mg) is safe and effective in immobilization-related hypercalcaemia and suggest that sepsis should be added to the list of risk factors for development of this syndrome.
制动相关的高钙血症是一种不常见但很重要的病症，常与尿路结石和骨质疏松症相关。在本研究中，5例平均制动3个月且平均校正血清钙为3.15 mmol/L的患者接受了剂量为10 mg至45 mg的静脉注射帕米膦酸盐治疗。所有患者在第3天时血钙恢复正常。患者1至3在治疗后不久即可活动，且血钙保持正常。在那些持续不能活动的患者中，数周后高钙血症复发。再次用帕米膦酸盐治疗后血钙又恢复正常。治疗过程中未观察到副作用。所有研究患者的骨吸收速率均增加，表现为尿羟脯氨酸/肌酐比值（中位数：范围）升高，为0.101:0.045 - 0.180（正常小于0.033），钙/肌酐比值升高，为2.50:0.69 - 3.63（正常小于0.50）。本研究中的患者均无发生制动相关高钙血症的常见危险因素，尽管所有5例患者均有严重脓毒症问题，我们推测这可能导致细胞因子释放，进而促成了高钙血症的发生。我们得出结论，帕米膦酸盐（低至10 mg的剂量）在制动相关高钙血症中安全有效，并建议脓毒症应被列入该综合征发生的危险因素清单。
