Ralston S H, Gardner M D, Dryburgh F J, Jenkins A S, Cowan R A, Boyle I T
Lancet. 1985 Oct 26;2(8461):907-10. doi: 10.1016/s0140-6736(85)90848-7.
Thirty-nine patients with cancer-associated hypercalcaemia were randomly allocated to receive aminohydroxypropylidene diphosphonate (APD), mithramycin, or corticosteroids and salmon calcitonin. Corticosteroids/calcitonin had the fastest calcium-lowering effect, owing mainly to an acute reduction in renal tubular calcium reabsorption; continued therapy over 9 days failed to suppress accelerated bone resorption, however, and most patients remained hypercalcaemic. Mithramycin also substantially reduced serum calcium within 24 h. A further dose on day 2 generally controlled hypercalcaemia until day 6 by reducing both bone resorption and renal tubular calcium reabsorption. By day 9, however, about 50% of the mithramycin-treated patients had started to relapse as bone resorption increased again. With APD serum calcium levels fell more slowly but progressively owing to effective suppression of bone resorption; by day 9 the control of hypercalcaemia was significantly better than in the other treatment groups. Symptoms of hypercalcaemia were greatly relieved, especially by APD.
三十九例癌症相关性高钙血症患者被随机分配接受氨羟丙基二膦酸盐（APD）、争光霉素或皮质类固醇及鲑鱼降钙素治疗。皮质类固醇/降钙素降低血钙的效果最快，主要是由于肾小管钙重吸收急性减少；然而，持续治疗9天未能抑制加速的骨吸收，大多数患者仍处于高钙血症状态。争光霉素在24小时内也能显著降低血清钙水平。第2天再给予一剂通常可通过减少骨吸收和肾小管钙重吸收来控制高钙血症直至第6天。然而，到第9天，约50%接受争光霉素治疗的患者因骨吸收再次增加而开始复发。使用APD时，由于有效抑制了骨吸收，血清钙水平下降较慢但呈渐进性；到第9天，高钙血症的控制明显优于其他治疗组。高钙血症的症状得到了极大缓解，尤其是使用APD时。
