Sakakibara M, Ichikawa M, Amano Y, Matsuzawa S, Agematsu K, Mori T, Koike K, Nakahata T, Komiyama A
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Leuk Res. 1993 May;17(5):441-3. doi: 10.1016/0145-2126(93)90100-y.
Recent reports have described clinical benefits of all-trans-retinoic acid (ATRA) therapy for acute promyelocytic leukemia (APL). This paper describes severe hypercalcemia (serum calcium: 18.7 mg/dl) in association with ATRA treatment in a 14 year old girl with APL. Serum parathyroid hormone (PTH) concentrations were normal (0.21 ng/ml), which precludes the possibility of primary hyperparathyroidism or ectopic PTH secretion as a cause of the hypercalcemia. As for the factors which can accelerate mineral resorption, there were no apparent increases in the levels of PTH-related protein (PTH-rP), prostaglandins and vitamin D metabolites. In our in vitro experiment, ATRA did not stimulate the leukemic cells to produce PTH-rP. We speculate that ATRA, like PTH, may increase osteoclastic activity and induce hypercalcemia.
近期报道描述了全反式维甲酸（ATRA）治疗急性早幼粒细胞白血病（APL）的临床益处。本文描述了一名14岁APL女童在接受ATRA治疗时出现严重高钙血症（血清钙：18.7mg/dl）。血清甲状旁腺激素（PTH）浓度正常（0.21ng/ml），这排除了原发性甲状旁腺功能亢进或异位PTH分泌作为高钙血症病因的可能性。至于可加速矿物质吸收的因素，甲状旁腺激素相关蛋白（PTH-rP）、前列腺素和维生素D代谢产物水平并无明显升高。在我们的体外实验中，ATRA并未刺激白血病细胞产生PTH-rP。我们推测，ATRA可能与PTH一样，会增加破骨细胞活性并诱发高钙血症。
