- 期刊
Clinical Study of Hypercalcemia in Patients with Hepatocellular Carcinoma
肝癌病人合併高血鈣症的臨床研究
摘要
惡性腫瘤合併高血鈣症是一種常見且重要之臨床問題，肝癌患者亦有合併高血鈣的現象發生。我們從民國76年元月至77年12月間，在630位住院病人中發現12例（佔1.8%）合併有高血鈣症。這些病人肝腫瘤面積較大，其中10位有肝臟兩葉之侵犯。有10位病人在肝癌初次被診斷時就發現有高血鈣症；另外兩位則在肝癌診斷3個月後才有高血鈣現象發生。高血鈣之臨床表現包括惡心、便秘、嗜睡及抑鬱等均為非特異性症狀；而且大都和肝癌的症狀混淆。這些病人的血清鈣值由113mg/dl至16.3mg/dl（平均值為13.6±2.7mg/dl）；全身骨核子掃描檢查均沒有發現有廣泛腫瘤骨轉移現象；除了一位病人的血清副甲狀腺荷爾蒙值增高外，其餘的低於正常值；而血清中1.25二羥基維他命D濃度有的增高、有的降低，有的則在正常範圍之內。為了治療高血鈣症，有5位病人接受靜脈輸液、利尿劑及類固醇之使用；有2位接受抑鈣素注射；有l位病人接受Epirubicin之化學治療，這些治療雖可降低血中鈣值但都是短暫性的降低。這些病人的正中存活率為2個月。大多數病人死於肝衰竭及上腸胃道出血。
並列摘要
From January 1987 to December 1988, 12 of 630 consecutive patients with hepatocellular carcinoma (HCC) were found to be associated with hypercalcemia. Ten of these 12 patients had tumors involvement in both lobes of the liver. Ten patients were noted to have hypercalcemia when HCC was first diagnosed, while the remaining 2 patients developed hypercalcemia 3 months after the diagnosis of HCC. Clinical manifestations of hypercalcemia were nonspecific, including anorexia, constipation, somnolence, and depression. These symptoms were often mixed and obscured with the symptoms of HCC. The serum calcium level of these 12 patients ranged from 11.3mg/dl to 16.3mg/dl (mean±SD: 13.6±2.7mg/dl). Whole body bone scanning did not show extensive bony metastasis in any one of them. All but one patient showed decreased serum parathyroid hormone level, while the serum 1,25(OH)2 vitamin D level varied. Five patients received supportive treatment with intravenous fluid, furosemide, and hydrocortisone, 2 other patients received calcitonin injection, and another one patient received chemotherapy with epirubicin infusion. The results of these treatments were fair and transient. The median survival of these 12 patients was 2 months, most of them died of hepatic failure and upper gastrointestinal bleeding.
延伸閱讀
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