恶性肿瘤合并高钙血症22例临床特点及预后分析

目的：分析恶性肿瘤伴高钙血症患者的临床诊治特点以及预后情况。方法：回顾性分析我科2004年1月-2008年6月收治的22例晚期恶性肿瘤合并高钙血症患者的临床资料，并随访观察其生存情况，分析其临床特点、诊治规律及影响预后的主要因素。结果：22例患者血钙浓度为2．78～4．37mmol／L，经双膦酸盐治疗后血钙均降至正常；发现高钙血症后生存时间为3～153天，中位生存时间仅为36天。单因素分析显示，血钙浓度〉3．0mmol／L及远处转移部位／〉3处的患者预后差（P=0．02和P=0．008）；多因素分析提示血钙最高值与远处转移部位的数目均可视为独立的危险因素（P=0．017和P=0．007），血钙值的升高和远处转移部位数目的增加均将增加死亡的风险。结论：高钙血症多见于恶性肿瘤晚期，预后差，应早期诊断，积极予双膦酸盐类药物降血钙治疗。血钙最高值与远处转移部位的数目是独立的预后因素。

Clinical characteristics and prognostic factors of 22 malignant hypercalcemia cases

Objective： To explore the incidence, clinical characteristics, diagnosis and treatment, survival and prognosis of malignant hypercalcemia patients. Methods：Clinical characteristics and survival data of 22 malignant hypercalcemia cases from Jan. 2004, to Jun. 2008, were retrospectively reviewed. Clinical characteristics, survival and prognostic factors were analyzed by SPSS 13.0 statistic software. Results：Blood calcium levels ranged from 2. 78 to 4. 37mmol/l, and they could reach normal level after treatment of bisphosphonates except 1 case died in 3 days ;their survival after experencing malignant hypercalcemia were from 3 days to 153 days, and the median time of survival was only 36 days. In the log-rank test ,patients with blood calcium level 〉 3.0mmol/l, more than 3 metastasis sites have a poor survival （ P = 0.02, P = 0. 008 ）, while age, bone metastasis, treatment and blood calcium level after therapy show no relationship with prognosis. In the COX proportional hazard model analysis, both blood calcium level and the number of metastasis sites are independent prognostic factors for survival time. Patients with blood calcium level 〉 3.0mmol/1 and more than 3 metastasis sites had a higher death hazard ratio （ RR = 3.68, P = 0. 017 ; RR = 5. 782, P = 0. 007）. Conclusion ： Malignant hypercalcemia with bad prognosis should be diagnosed and treatmented as early as possible, blood calcium level and the number of metastasis sites are important independent factors, which be worth of a further investigation for preventive treatment of bisphosphonates to improve prognosis.