恶性肿瘤相关性高钙血症中甲状旁腺激素样蛋白血清水平升高。

Increased serum levels of a parathyroid hormone-like protein in malignancy-associated hypercalcemia.

作者信息

Budayr A A, Nissenson R A, Klein R F, Pun K K, Clark O H, Diep D, Arnaud C D, Strewler G J

机构信息

Veterans Administration Medical Center, San Francisco, California.

出版信息

Ann Intern Med. 1989 Nov 15;111(10):807-12. doi: 10.7326/0003-4819-111-10-807.

DOI:10.7326/0003-4819-111-10-807

PMID:2817628

Abstract

STUDY OBJECTIVE

To measure the serum levels of a newly described parathyroid hormone-like protein (PLP) which was isolated from malignant tumors associated with hypercalcemia, and determine whether PLP is a humoral factor in malignancy-associated hypercalcemia.

DESIGN

A cross-sectional study of serum levels of PLP using a newly developed radioimmunoassay.

SETTING

A university-affiliated Veterans Administration hospital in San Francisco, California, a University hospital in Hong Kong, and a private hospital in Danville, Pennsylvania.

PATIENTS

Patients with hypercalcemia (calcium greater than 2.65 mmol/L) and a diagnosis of malignancy were studied. Control groups included normocalcemic patients with malignancy, patients with hyperparathyroidism, and normal subjects.

MEASUREMENTS AND MAIN RESULTS

Serum immunoreactive PLP (iPLP) levels in normal subjects were less than 2.5 pmol eq/L (10 pg/mL), and 68% of subjects had undetectable levels. The serum concentration of iPLP was normal in 15 of 16 hypercalcemic patients with hyperparathyroidism. Serum iPLP was increased (greater than 2.5 pmol eq/L) in 36 of 65 (55%) patients with malignancy-associated hypercalcemia, with a mean value of 6.1 +/- 0.9 pmol eq/L (24 pg/mL). In a subgroup of patients with solid tumors serum iPLP was increased in 30 (71%) of 42 hypercalcemic patients, with a mean value of 6.5 +/- 0.9 pmol eq/L. Serum iPLP was elevated in only 3 of 23 normocalcemic patients with cancer. In patients with solid malignancies (n = 59), levels of iPLP were positively correlated with the total serum calcium (r = 0.43, P less than 0.01).

CONCLUSION

The data indicate a relation between the serum concentration of iPLP and the presence of hypercalcemia in solid malignancies. The results support a role for PLP as a humoral mediator of hypercalcemia in most patients with solid tumors. Measurement of iPLP should be useful in the differential diagnosis of hypercalcemia.

摘要

研究目的

测定一种新发现的甲状旁腺激素样蛋白（PLP）的血清水平，该蛋白是从与高钙血症相关的恶性肿瘤中分离出来的，并确定PLP是否为恶性肿瘤相关性高钙血症的一种体液因子。

设计

采用新开发的放射免疫分析法对PLP血清水平进行横断面研究。

地点

加利福尼亚州旧金山一家大学附属退伍军人管理局医院、香港一家大学医院以及宾夕法尼亚州丹维尔一家私立医院。

患者

研究高钙血症（血钙大于2.65 mmol/L）且诊断为恶性肿瘤的患者。对照组包括血钙正常的恶性肿瘤患者、甲状旁腺功能亢进患者和正常受试者。

测量指标及主要结果

正常受试者血清免疫反应性PLP（iPLP）水平低于2.5 pmol eq/L（10 pg/mL），68%的受试者检测不到该水平。16例甲状旁腺功能亢进的高钙血症患者中有15例血清iPLP浓度正常。65例恶性肿瘤相关性高钙血症患者中有36例（55%）血清iPLP升高（大于2.5 pmol eq/L），平均值为6.1±0.9 pmol eq/L（24 pg/mL）。在实体瘤患者亚组中，42例高钙血症患者中有30例（71%）血清iPLP升高，平均值为6.5±0.9 pmol eq/L。23例血钙正常的癌症患者中只有3例血清iPLP升高。在实体恶性肿瘤患者（n = 59）中，iPLP水平与血清总钙呈正相关（r = 0.43，P < 0.01）。