| Objectives of the study:To analyze the etiological components of hypercalcemia in hospitalized patients and compare the clinical characteristics and treatment and efficacy of PTH-dependent hypercalcemia with non-PTH-dependent hypercalcemia,in order to improve the understanding of hypercalcemia,provide clinical diagnosis and treatment ideas,and thus improve clinical diagnosis and treatment.Research methods of the study:The clinical data of 405 patients admitted to various departments of the First Hospital of Jilin University and diagnosed with hypercalcemia between August 2018 and September 2022 were collected and divided into PTH-dependent hypercalcemia group and non-PTH-dependent hypercalcemia group according to the level of PTH secreted by parathyroid glands.The general data(gender,age),duration of hospitalization,underlying diseases,and biochemical data of the enrolled patients(blood calcium,parathyroid hormone,blood albumin,blood phosphorus,creatinine,urea nitrogen,alkaline phosphatase,blood uric acid,thyroid stimulating hormone,free T3,free T4,liver transaminases,white blood cells,hemoglobin,platelets),electrocardiogram,imaging findings(bone density test,static parathyroid imaging,urinary ultrasound,bone scan,DR/CT/MRI),clinical manifestations,treatment plan,The data were used to analyze the etiological composition of hypercalcemia in hospitalized patients and to compare the differences in general information,clinical features,biochemical characteristics,imaging tests,treatment methods,and treatment effects between the two groups.Results of the study:(1)Among the 405 patients with hypercalcemia,94 were in the PTH-dependent hypercalcemia group and 311 in the non-PTH-dependent hypercalcemia group,of whom 191 were male and 214 were female,with a mean age of 60(51,68)years and a mean length of stay of 12(6.5,19)days.The hospitalization time for the NPHC group was longer at 13(6,20)days compared to the PHC group at 8.5(7,15)days(P<0.01).There were significantly more women than men in the PTH-dependent hypercalcemia group,with a significant difference in the gender composition of the two groups(P<0.001).There was no significant difference in the age of the patients in the two groups(P>0.05).(2)In the PTH-dependent hypercalcemia group,there were 92 cases of primary hyperparathyroidism(22.72%)and 2 cases of tertiary hyperparathyroidism(0.49%);in the non-PTH-dependent hypercalcemia group,there were 94 cases of multiple myeloma(23.21%),64 cases of lung cancer(15.80%),43 cases of breast cancer(10.62%),22 cases of non-Hodgkin’s lymphoma(5.43%).plasma cell leukemia 12(2.96%),metastatic carcinoma 7(1.73%),esophageal squamous carcinoma 10(2.47%),renal clear cell carcinoma 5(1.23%),skin squamous carcinoma 2(0.49%),bladder carcinoma 2(0.49%),bile duct carcinoma 2(0.49%),gallbladder carcinoma 3(0.74%),renal failure 6(1.48%),hepatocellular carcinoma in 6cases(1.48%),cirrhosis of the liver in its decompensated stage in 5 cases(1.23%),pulmonary granulomatous disease in 2 cases(0.49%),myelofibrosis in 2 cases(0.49%),laryngeal cancer in 2 cases(0.49%),acute lymphoblastic leukemia in 5 cases(1.23%),hyperthyroidism in 3 cases(0.74%),rectal cancer in 2 cases(0.49%),carcinoma of the floor of the mouth in 1 case(0.25%),and 1 case of Waldenstr?m’s macroglobulinemia(0.25%).(3)After correction for blood albumin,the corrected blood calcium level was lower in the PTH-dependent hypercalcemia group 2.86(2.70,3.20)mmol/L than the pre-corrected level 2.90(2.75,3.27)mmol/L,and in the non-PTH-dependent hypercalcemia group 3.18(2.93,3.54)mmol/L was higher than the pre-calibration level 2.99(2.81,3.31)mmol/L(P<0.001).(4)The proportion of patients with mild hypercalcemia was significantly higher in the PTH-dependent hypercalcemia group than in the non-PTH-dependent hypercalcemia group(P<0.001);the proportion of patients with severe hypercalcemia was significantly higher in the non-PTH-dependent hypercalcemia group than in the PTH-dependent hypercalcemia group(P<0.01);the proportion of patients with the hypercalcemic crisis was higher in the non-PTH-dependent hypercalcemia group than in the PTH-dependent The proportion of patients with hypercalcemia in the non-PTH-dependent hypercalcemia group was higher than that in the PTH-dependent hypercalcemia group(P<0.05).(5)The highest blood calcium value,post-treatment blood calcium value,blood P,ALP,Cr,BUN,and BUA in the non-PTH-dependent hypercalcemia group were significantly higher than those in the PTH-dependent hypercalcemia group,and the PTH level was lower than that in the PTH-dependent hypercalcemia group(P<0.01).(6)The proportion of patients showing no symptoms or a single systemic clinical symptom was significantly higher in the PTH-dependent hypercalcemia group than in the non-PTH-dependent hypercalcemia group,and the proportion of patients showing two systemic clinical symptoms was significantly lower than in the non-PTH-dependent hypercalcemia group(P<0.01).There was no significant difference in the probability of having three or four systemic clinical symptoms between the two groups(P>0.05).(7)The incidence of electrophysiological abnormalities in the cardiovascular system was higher in the non-PTH-dependent hypercalcemia group(55.31%)than in the PTH-dependent hypercalcemia group(29.79%)(P<0.001);the incidence of lesions in the skeletal system was greater in the non-PTH-dependent hypercalcemia group(38.91%)than in the PTH-dependent hypercalcemia group(13.83%)(P<0.001).The prevalence of urinary system lesions was greater in the PTH-dependent hypercalcemia group(40.43%)than in the non-PTH-dependent hypercalcemia group(4.82%)(P<0.001).(8)Forty-eight patients in the PTH-dependent hypercalcemia group underwent surgery,with postoperative pathology suggesting parathyroid hyperplasia in 0 cases,parathyroid adenoma in 46 cases(95.83%),and parathyroid adenocarcinoma in 2 cases(4.17%).(9)The proportion of patients in the PTH-dependent hypercalcemia group with 2 means of calcium lowering was greater than that in the non-PTH-dependent hypercalcemia group,and the proportion of patients with 3means of calcium lowering was less than that in the non-PTH-dependent hypercalcemia group(P<0.01).(10)The proportion of patients with good outcomes in the PTH-dependent hypercalcemia group(61.80%)was significantly higher than that in the non-PTH-dependent hypercalcemia group(20.00%)(P<0.001),and the proportion of patients who did not recover or gave up discharge in the non-PTH-dependent hypercalcemia group(20.98%)was higher than that in the PTH-dependent hypercalcemia group(8.99%)(P<0.05).Conclusion of the study:(1)The etiology of hypercalcemia in hospitalized patients is predominantly HCM and to a lesser extent PHPT.The etiology of HCM is predominantly multiple myeloma and to a lesser extent lung cancer.(2)PHPT is the main cause of PTH-dependent hypercalcemia and HCM is the main cause of non-PTH-dependent hypercalcemia.(3)The corrected blood calcium is significantly higher than the pre-corrected blood calcium in non-PTH-dependent hypercalcemia,and the corrected blood calcium is significantly lower than the pre-corrected blood calcium in PTH-dependent hypercalcemia.(4)Patients with hypercalcemia are more likely to have multiple systemic clinical manifestations and PTH-dependent hypercalcemia is more likely to be complicated by urinary stones.(5)The use of fluids and diuretics is the basic clinical treatment for hypercalcemia,in addition to calcitonin and bisphosphonates.(6)PTH-dependent hypercalcemia is significantly more effective than non-PTH-dependent hypercalcemia. |
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