非小細胞肺癌高鈣血癥多學科綜合治療近期療效觀察

摘要：目的 探討以化療為基礎，聯合放射性核素及雙磷酸鹽的綜合治療手段治療肺癌骨轉移性高鈣血癥的近期臨床療效。方法 采用非小細胞肺癌含鉑化療方案聯合放射性核素89SrCL2及唑來膦酸治療33例肺癌骨轉移所導致的高鈣血癥，動態觀察患者血鈣濃度變化。結果 33例患者高鈣血癥有效緩解23例，總有效緩解率為69.7%；化療有效組12例，高鈣血癥有效緩解11例，緩解率為91.7%，化療無效組21例，高鈣血癥有效緩解12例，緩解率為57.1%，化療有效組高鈣血癥的有效緩解率高于化療無效組，差異有統計學意義（χ2=4.309，P=0.042）。化療有效組及無效組高鈣血癥有效緩解的平均持續時間分別為（82.2±12.4）d及（68.5±7.6）d，差異有統計學意義（t=3.007，P=0.011）。結論 化療聯合放射性核素及雙磷酸鹽的綜合治療手段可以有效緩解部分非小細胞肺癌骨轉移性高鈣血癥，其中化療有效患者接受該治療手段顯示出更好的療效。

關鍵詞：關鍵詞 非小細胞肺癌；惡性高鈣血癥；綜合治療

中圖分類號：R730.53 文獻標識碼：A

Hort-term Efficacy Observation of Multidisciplinary Synthetic Therapy of Non-small-cell Lung Cancer

with Hypercalcemia

WANG Qiong1， DENG Yong-Jun2， SHI Yun-Fei3， LIU Huang-Peng2， LI Jue2

（1. Department of Pharmacy， The People's Hospital of Luoping County， Luoping 655800，Yunnan，China；2. Department of Thoracic Surgery， The Fourth Affiliated Hospital of Kunming Medical University， Kunming 650017， Yunnan，China；3. Department of Thoracic Surgery，The First Affiliated Hospital of Kunming Medical University，Kunming 6500327， Yunnan，China）

Abstract：Objective To explore the short-term clinical effects of multidisciplinary synthetic therapy of chemotherapy combined with radionuclide and bisphosphonates in treatment on 33 non-small-cell lung cancer patients with hypercalcemia. Methods 33 non-small-cell lung cancer patients with hypercalcemia were treated with platinum-based chemotherapy combined with radionuclide 89SrCL2 and zoledronic acid by the support of Granulocyte-macrophage colony-stimulating factor （GM-CSF）. The level of blood-calcium was observed regularly and the efficacy was evaluated. Results Hypercalcemia in 23 cases were found to be alleviated effectively and the alleviation rate was 69.7%， thereinto， 11 cases happened in 12 chemotherapy-effective patients （chemotherapy-effective group） and the other 12 cases occurred in 21 chemotherapy-ineffective patients （chemotherapy-ineffective group）. The effective alleviation rate of hypercalcemia in chemotherapy-effective group was higher that in chemotherapy-ineffective group， the difference was statistically significant （91.7% vs. 57.1%，χ2=4.309， P=0.042）. The average duration of the alleviation of hypercalcemia effectively in chemotherapy-effective group was longer than that in chemotherapy-ineffective group （82.2±12.4d vs. 68.5±7.6d， t=3.007， P=0.011）. Conclusion Multidisciplinary synthetic therapy of chemotherapy combined with radionuclide and bisphosphonates could effectively alleviated part patients with malignant hypercalcemia. It seemed that these patients who were sensitive to chemotherapy showed better clinical effect.

Key words：Non-small cell lung cancer； Malignant hypercalcemia；Combined therapy

骨轉移是晚期惡性腫瘤患者常見的并發癥之一，其中部分骨轉移患者常合并高鈣血癥，據文獻報告其發生率為5%～10%[1]， 多見于肺癌、乳腺癌、多發性骨髓瘤、腎癌、前列腺癌等腫瘤。擺在腫瘤醫師面前的一個難題是如何有效地緩解骨痛降低高鈣血癥，提高患者的生活質量。目前放射性核素及雙膦酸鹽整體治療的效果較好，并越來越多地為臨床醫生接受[2]，在這方面已進行的臨床試驗大體上顯示這些治療手段在控制由轉移性骨損害所致的疼痛和高鈣血癥有效，但其療效持續時間較短，容易再出現新的骨轉移病灶[3]，其中一個重要原因是忽略了同時對原發腫瘤的全身治療。……