Davies M, Hayes M E, Yin J A, Berry J L, Mawer E B
University Department of Medicine, Manchester Royal Infirmary, United Kingdom.
J Clin Endocrinol Metab. 1994 May;78(5):1202-7. doi: 10.1210/jcem.78.5.8175979.
High serum concentrations of 1,25-dihydroxyvitamin D [1,25-(OH)2D] can occur with hypercalcemia in malignant lymphoma. We have investigated the potential for abnormal vitamin D metabolism by giving a single oral dose of 25-hydroxyvitamin D (25OHD) in 10 lymphoma patients (8 Hodgkin's and 2 T-cell) and 7 controls. Serum 25OHD increased similarly in both groups (peak concentrations, 114.1 +/- 9.5 vs. 123.9 +/- 9.6 nmol/L). In controls, serum calcium and PTH did not change after treatment [calcium, 2.31 +/- 0.02 and 2.33 +/- 0.02 mmol/L (mean +/- SEM); PTH, 21.6 +/- 4.0 and 25.4 +/- 4.3 ng/L] 1,25-(OH)2D increased within the normal range from [median (range)] 81 (48-125) to 117 (91-156) pmol/L. In lymphoma patients, serum calcium increased from 2.29 +/- 0.04 to 2.40 +/- 0.06 mmol/L (P = 0.03), PTH decreased from 12.9 +/- 2.6 to 8.0 +/- 1.9 ng/L (P = 0.06), and one patient became hypercalcemic (2.92 mmol/L). Serum 1,25-(OH)2D became supranormal in 6 lymphoma patients; the group median rose from 74.5 (46-180) to 151 (120-487) pmol/L; this peak response differed from that in the controls (P = 0.019). Lymph node and spleen cells from a patient with T-cell lymphoma synthesized [3H]1,25-(OH)2D3 from [3H] 25OHD3 in vitro. The data suggest that abnormal production of 1,25-(OH)2D in lymphoma may be more common than previously recognized given an adequate supply of precursor 25OHD and provide further evidence for the extrarenal synthesis of 1,25-(OH)2D in this condition.
恶性淋巴瘤患者高钙血症时可出现血清1,25 - 二羟维生素D[1,25-(OH)₂D]浓度升高。我们给予10例淋巴瘤患者（8例霍奇金淋巴瘤和2例T细胞淋巴瘤）及7例对照单次口服一剂25 - 羟维生素D(25OHD)，研究维生素D代谢异常的可能性。两组血清25OHD升高情况相似（峰值浓度分别为114.1±9.5与123.9±9.6 nmol/L）。对照组治疗后血清钙和甲状旁腺激素（PTH）未改变[钙，2.31±0.02与2.33±0.02 mmol/L(均值±标准误)；PTH，21.6±4.0与25.4±4.3 ng/L]，1,25-(OH)₂D在正常范围内从[中位数（范围）]81(48 - 125)升至117(91 - 156) pmol/L。淋巴瘤患者血清钙从2.29±0.04升至2.40±0.06 mmol/L(P = 0.03)，PTH从12.9±2.6降至8.0±1.9 ng/L(P = 0.06)，1例患者出现高钙血症(2.92 mmol/L)。6例淋巴瘤患者血清1,25-(OH)₂D超过正常范围；该组中位数从74.5(46 - 180)升至151(120 - 487) pmol/L；此峰值反应与对照组不同(P = 0.019)。1例T细胞淋巴瘤患者的淋巴结和脾细胞在体外可将[³H]25OHD₃合成[³H]1,25-(OH)₂D₃。数据表明，在有足够前体25OHD供应的情况下，淋巴瘤中1,25-(OH)₂D的异常产生可能比之前认识到的更常见，并为这种情况下1,25-(OH)₂D的肾外合成提供了进一步证据。
