Fuss M, Karmali R, Pepersack T, Bergans A, Dierckx P, Prigogine T, Bergmann P, Corvilain J
Université Libre de Bruxelles, Service de Médecine Interne, Belgium.
Q J Med. 1988 Nov;69(259):869-78.
The risk of tuberculous patients to develop hypercalcemia was investigated in 33 patients aged 19 to 80. Twenty-two of the 33 received no vitamin D supplements. Before antituberculous chemotherapy serum calcium corrected for albumin and urinary calcium levels were normal, serum 25-hydroxyvitamin D (25(OH)D) levels were low, but serum 1,25(OH)2D levels, oral calcium load test and intestinal 47Ca absorption were normal. After 17 to 34 days of chemotherapy serum calcium corrected for albumin and 1,25(OH)2D levels were lower without change in serum D-binding protein. In 11 patients 25(OH)D, 50 micrograms/day, was given orally for two months. 25(OH)D given three days before chemotherapy in five patients induced an increase of levels of 1,25(OH)2D which was greater than in 10 control patients with similar serum levels of 25(OH)D. When chemotherapy was added to 25(OH)D, the five patients showed high normal 1,25(OH)2D levels. The last six patients received 25(OH)D together with or after starting chemotherapy. None of the 33 patients developed hypercalcemia, even when supplemented with 25(OH)D for two months. It appears that hypercalcemia is uncommon in tuberculosis.
对33例年龄在19至80岁之间的结核病患者发生高钙血症的风险进行了研究。33例患者中有22例未补充维生素D。在抗结核化疗前，校正白蛋白后的血清钙和尿钙水平正常，血清25-羟维生素D（25(OH)D）水平较低，但血清1,25(OH)₂D水平、口服钙负荷试验和肠道⁴⁷Ca吸收正常。化疗17至34天后，校正白蛋白后的血清钙和1,25(OH)₂D水平降低，血清D结合蛋白无变化。11例患者口服25(OH)D，50微克/天，持续两个月。5例患者在化疗前三天给予25(OH)D，其1,25(OH)₂D水平升高幅度大于10例血清25(OH)D水平相似的对照患者。当在25(OH)D基础上加用化疗时，这5例患者的1,25(OH)₂D水平处于高正常范围。最后6例患者在开始化疗时或化疗后同时接受25(OH)D。33例患者中无一例发生高钙血症，即使补充25(OH)D两个月也是如此。看来高钙血症在结核病中并不常见。
