Wimalawansa S J
Department of Medicine (Endocrinology) and Chemical Pathology, Royal Postgraduate Medical School, London, UK.
Clin Endocrinol (Oxf). 1994 Nov;41(5):591-5. doi: 10.1111/j.1365-2265.1994.tb01823.x.
Hypercalcaemia of malignancy (HM) is a common metabolic complication associated with cancer. The hypocalcaemic effects of medications used to reduce serum calcium levels in HM are short lived and relapse in hypercalcaemia is not uncommon. Pamidronate is one of the most commonly used bisphosphonates in the treatment of HM but there are no specific guidelines for the frequency of use of this drug in recurrent hypercalcaemia. This study was conducted to assess the optimum frequency of pamidronate therapy necessary to maintain normocalcaemia in patients with HM.
Thirty-four patients with HM were randomly allocated into two groups and treated with intravenous pamidronate administered every 14th or 21st day for 16 weeks (n = 17 each group). Serum calcium and urinary hydroxyproline creatinine ratio were measured at weekly intervals.
The calcium-lowering effect of pamidronate was apparent by 48 hours and normocalcaemia was maintained for an average of 15 days. When the drug was administered every 3 weeks, hypercalcaemia and associated symptoms developed in 50% of patients (22 separate episodes) during the 3rd week, before the next dose of pamidronate. The incidence of symptomatic hypercalcaemia was significantly decreased (10%, 8 separate episodes, P < 0.01) and survival was improved (P < 0.05) in patients who received pamidronate every 2nd week, thereby minimizing the unpleasant and potentially dangerous effects of hypercalcaemia.
Intravenous pamidronate 60 mg/dose, administered every two weeks, can maintain normocalcaemia in the vast majority of patients with hypercalcaemia of malignancy.
恶性肿瘤高钙血症（HM）是一种与癌症相关的常见代谢并发症。用于降低HM患者血清钙水平的药物的降钙作用持续时间短，高钙血症复发并不罕见。帕米膦酸是治疗HM最常用的双膦酸盐之一，但对于该药物在复发性高钙血症中的使用频率尚无具体指南。本研究旨在评估维持HM患者血钙正常所需的帕米膦酸治疗最佳频率。
34例HM患者被随机分为两组，分别接受每14天或21天静脉注射帕米膦酸治疗16周（每组n = 17）。每周测量血清钙和尿羟脯氨酸肌酐比值。
帕米膦酸的降钙作用在48小时时明显，血钙正常平均维持15天。当每3周给药一次时，50%的患者（22次单独发作）在第3周、下次帕米膦酸给药前出现高钙血症及相关症状。接受每2周一次帕米膦酸治疗的患者中，症状性高钙血症的发生率显著降低（10%，8次单独发作，P < 0.01），生存率提高（P < 0.05），从而将高钙血症的不良和潜在危险影响降至最低。
每两周静脉注射60mg/剂量的帕米膦酸可使绝大多数恶性肿瘤高钙血症患者维持血钙正常。
