Sodium, potassium, calcium, bicarbonate, thiab kua dej sib npaug hauv cov ntshav yog lub hauv paus rau kev tswj lub cev kev ua haujlwm hauv lub cev. Muaj tsis muaj kev tshawb fawb txog magnesium ion teeb meem. Thaum ntxov li xyoo 1980, magnesium tau hu ua "tsis nco qab electrolyte". Nrog rau kev tshawb pom ntawm magnesium tshwj xeeb raws thiab thauj khoom, nrog rau kev nkag siab ntawm physiological thiab hormonal kev tswj hwm ntawm magnesium homeostasis, tib neeg kev nkag siab ntawm lub luag haujlwm ntawm magnesium nyob rau hauv cov tshuaj kho mob yog tas li tob.
Magnesium yog qhov tseem ceeb rau kev ua haujlwm ntawm tes thiab kev noj qab haus huv. Magnesium feem ntau muaj nyob rau hauv daim ntawv ntawm Mg2+, thiab muaj nyob rau hauv tag nrho cov hlwb ntawm tag nrho cov kab mob, los ntawm cov nroj tsuag mus rau siab dua cov tsiaj. Magnesium yog ib qho tseem ceeb rau kev noj qab haus huv thiab lub neej, vim nws yog ib qho tseem ceeb cofactor ntawm cellular zog qhov chaw ATP. Magnesium feem ntau koom nrog hauv cov txheej txheem physiological tseem ceeb ntawm cov hlwb los ntawm kev khi rau nucleotides thiab tswj kev ua haujlwm enzyme. Txhua qhov kev cuam tshuam ATPase xav tau Mg2 +- ATP, suav nrog kev cuam tshuam txog RNA thiab DNA ua haujlwm. Magnesium yog ib cofactor ntawm ntau pua cov tshuaj tiv thaiv enzymatic hauv cov hlwb. Tsis tas li ntawd, magnesium kuj tswj cov piam thaj, lipid, thiab protein metabolism. Magnesium yog koom nrog hauv kev tswj hwm kev ua haujlwm neuromuscular, tswj lub plawv atherosclerosis, vascular tone, hormone secretion, thiab tso tawm N-methyl-D-aspartate (NMDA) hauv nruab nrab paj hlwb. Magnesium yog tus xa xov thib ob koom nrog hauv kev taw qhia intracellular thiab tus tswj hwm ntawm circadian atherosclerosis cov noob uas tswj cov circadian atherosclerosis ntawm cov kab mob lom.
Muaj kwv yees li 25 g ntawm magnesium nyob rau hauv tib neeg lub cev, feem ntau khaws cia hauv cov pob txha thiab cov ntaub so ntswg. Magnesium yog ib qho tseem ceeb intracellular ion thiab qhov thib ob loj tshaj plaws intracellular cation tom qab poov tshuaj. Hauv cov hlwb, 90% txog 95% ntawm magnesium khi rau ligands xws li ATP, ADP, citrate, proteins, thiab nucleic acids, thaum tsuas yog 1% mus rau 5% ntawm cov magnesium intracellular muaj nyob hauv daim ntawv dawb. Intracellular tsis muaj magnesium concentration yog 1.2-2.9 mg / dl (0.5-1.2 mmol / L), uas zoo ib yam li cov concentration ntawm extracellular. Hauv plasma, 30% ntawm cov khoom siv magnesium khi rau cov proteins feem ntau los ntawm cov rog dawb. Cov neeg mob uas muaj hnub nyoog ntev ntawm cov roj fatty acids dawb feem ntau muaj qis dua cov ntshav magnesium ntau, uas yog qhov sib txawv ntawm qhov kev pheej hmoo ntawm cov kab mob plawv thiab cov kab mob metabolic. Kev hloov pauv hauv cov rog dawb, nrog rau qib EGF, insulin, thiab aldosterone tuaj yeem cuam tshuam rau cov ntshav magnesium.
Muaj peb lub ntsiab lus tswj hwm ntawm magnesium: txoj hnyuv ( tswj kev noj zaub mov magnesium nqus), cov pob txha ( khaws cia magnesium hauv daim ntawv ntawm hydroxyapatite ), thiab ob lub raum ( tswj cov zis magnesium excretion ). Cov kab ke no yog kev sib koom ua ke thiab sib koom ua ke, ua ke tsim lub plab pob txha raum axis, lub luag haujlwm rau kev nqus, pauv, thiab tawm ntawm magnesium. Kev tsis sib haum xeeb ntawm magnesium metabolism tuaj yeem ua rau cov txiaj ntsig pathological thiab physiological
Cov khoom noj uas muaj magnesium muaj xws li nplej, taum, txiv ntoo, thiab zaub ntsuab (magnesium yog cov ntsiab lus tseem ceeb ntawm chlorophyll). Kwv yees li 30% mus rau 40% ntawm kev noj zaub mov magnesium tau txais los ntawm txoj hnyuv. Kev nqus feem ntau tshwm sim hauv cov hnyuv me los ntawm kev thauj mus los ntawm intercellular, cov txheej txheem passive cuam tshuam nrog kev sib txuas ntawm cov hlwb. Cov hnyuv loj tuaj yeem tswj hwm magnesium nqus tau zoo los ntawm kev hloov pauv TRPM6 thiab TRPM7. Kev tsis ua haujlwm ntawm lub plab hnyuv TRPM7 tuaj yeem ua rau muaj qhov tsis txaus ntawm magnesium, zinc, thiab calcium, uas ua rau muaj kev cuam tshuam rau kev loj hlob ntxov thiab ciaj sia tom qab yug me nyuam. Magnesium absorption yog cuam tshuam los ntawm ntau yam, suav nrog magnesium kom tsawg, plab pH nqi, cov tshuaj hormones (xws li estrogen, insulin, EGF, FGF23, thiab parathyroid hormone [PTH]), thiab plab microbiota.
Nyob rau hauv lub raum, lub raum tubules reabsorb magnesium los ntawm ob qho tib si extracellular thiab intracellular txoj kev. Tsis zoo li feem ntau ions xws li sodium thiab calcium, tsuas yog ib qho me me (20%) ntawm magnesium yog reabsorbed nyob rau hauv cov tubules ze, thaum feem ntau (70%) ntawm magnesium yog reabsorbed nyob rau hauv lub Heinz voj. Hauv cov tubules ze ze thiab cov ceg tawv ntawm Heinz voj, magnesium reabsorption feem ntau yog tsav los ntawm cov concentration gradients thiab daim nyias nyias. Claudin 16 thiab Claudin 19 tsim magnesium raws nyob rau hauv cov ceg tuab ntawm Heinz voj, thaum Claudin 10b pab tsim ib qho zoo intraluminal voltage hla lub hlwb epithelial, tsav tsheb magnesium ion reabsorption. Nyob rau hauv lub distal tubules, magnesium finely tswj intracellular reabsorption (5% ~ 10%) los ntawm TRPM6 thiab TRPM7 ntawm lub xov tooj ntawm tes, yog li txiav txim siab qhov kawg tso zis magnesium excretion.
Magnesium yog ib qho tseem ceeb ntawm cov pob txha, thiab 60% ntawm magnesium nyob rau hauv tib neeg lub cev yog khaws cia rau hauv cov pob txha. Lub exchangeable magnesium nyob rau hauv cov pob txha muab dynamic reserves tswj plasma physiological concentrations. Magnesium txhawb kev tsim cov pob txha los ntawm kev cuam tshuam cov haujlwm ntawm osteoblasts thiab osteoclasts. Kev noj cov magnesium ntxiv tuaj yeem ua rau cov pob txha pob txha cov ntsiab lus, yog li txo qhov kev pheej hmoo ntawm pob txha thiab pob txha pob txha thaum laus. Magnesium muaj ob lub luag haujlwm hauv kev kho pob txha. Thaum lub sijhawm mob hnyav, magnesium tuaj yeem txhawb kev qhia ntawm TRPM7 hauv macrophages, magnesium nyob ntawm cytokine ntau lawm, thiab txhawb kev tiv thaiv kab mob microenvironment ntawm pob txha tsim. Thaum lub sij hawm lig remodeling theem ntawm pob txha kho, magnesium tuaj yeem cuam tshuam osteogenesis thiab inhibit hydroxyapatite nag lossis daus. TRPM7 thiab magnesium kuj koom nrog hauv cov txheej txheem ntawm vascular calcification los ntawm kev cuam tshuam kev hloov pauv ntawm vascular du leeg hlwb mus rau osteogenic phenotype.
Cov piam thaj ib txwm muaj magnesium hauv cov neeg laus yog 1.7 ~ 2.4 mg / dl (0.7 ~ 1.0 mmol / L). Hypomagnesemia yog hais txog cov ntshav magnesium concentration hauv qab 1.7 mg / dl. Feem ntau cov neeg mob uas muaj ciam teb hypomagnesemia tsis muaj cov tsos mob pom tseeb. Vim tias qhov muaj peev xwm ua tau ntev ntev ntawm magnesium deficiency nyob rau hauv cov neeg mob uas muaj cov piam thaj magnesium ntau dua 1.5 mg / dl (0.6 mmol / L), qee qhov qhia kom nce qib qis rau hypomagnesemia. Txawm li cas los xij, qib no tseem muaj kev tsis sib haum xeeb thiab xav tau kev kuaj mob ntxiv. 3% ~ 10% ntawm cov pejxeem feem ntau muaj hypomagnesemia, thaum qhov tshwm sim ntawm cov neeg mob ntshav qab zib hom 2 (10% ~ 30%) thiab cov neeg mob pw hauv tsev kho mob (10% ~ 60%) yog siab dua, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob hnyav (ICU) cov neeg mob, qhov tshwm sim ntau tshaj 65%. Ntau qhov kev tshawb fawb tau pom tias hypomagnesemia yog txuam nrog kev pheej hmoo ntawm kev tuag tag nrho thiab cov kab mob plawv ntsig txog kev tuag.
Cov tsos mob ntawm hypomagnesemia muaj xws li cov tsos mob uas tsis yog tshwj xeeb xws li qaug zog, cov leeg nqaij, lossis cov leeg tsis muaj zog los ntawm kev noj zaub mov tsis txaus, nce plab hnyuv, txo lub raum reabsorption, lossis redistribution ntawm magnesium los ntawm sab nraud mus rau sab hauv lub hlwb (Daim duab 3B). Hypomagnesemia feem ntau ua ke nrog lwm cov kab mob electrolyte, suav nrog hypocalcemia, hypokalemia, thiab metabolic alkalosis. Yog li ntawd, hypomagnesemia yuav raug saib xyuas, tshwj xeeb tshaj yog nyob rau hauv feem ntau cov chaw kho mob uas cov ntshav magnesium qib tsis niaj hnub ntsuas. Tsuas yog nyob rau hauv qhov hnyav hypomagnesemia (cov ntshav magnesium <1.2 mg / dL [0.5 mmol / L]), cov tsos mob xws li txawv txav neuromuscular excitability (lub dab teg pob taws spasms, qaug dab peg, thiab tshee), mob plawv abnormalities (arrhythmias thiab vasoconstriction), thiab metabolic ntshawv siab. Hypomagnesemia yog txuam nrog nce mus pw hauv tsev kho mob thiab cov neeg tuag, tshwj xeeb tshaj yog thaum nrog hypokalemia, qhia txog qhov tseem ceeb ntawm cov tshuaj magnesium.
Cov ntsiab lus magnesium hauv cov ntshav muaj tsawg dua 1%, yog li cov ntshav magnesium tsis tuaj yeem cuam tshuam tag nrho cov ntsiab lus magnesium hauv cov ntaub so ntswg. Kev tshawb fawb tau pom tias txawm tias cov ntshav magnesium concentration yog qhov qub, cov ntsiab lus ntawm magnesium intracellular yuav depleted. Yog li, txiav txim siab tsuas yog cov ntsiab lus magnesium hauv cov ntshav yam tsis xav txog kev noj zaub mov magnesium kom tsawg thiab tso zis tsis txaus yuav ua rau pom qhov tsis txaus ntawm cov tshuaj magnesium.
Cov neeg mob hypomagnesemia feem ntau ntsib hypokalemia. Cov tawv nqaij hypokalemia feem ntau cuam tshuam nrog magnesium tsis txaus, thiab nws tsuas yog kho tau zoo tom qab magnesium qib rov qab mus rau qhov qub. Magnesium deficiency tuaj yeem txhawb nqa cov poov tshuaj tso tawm los ntawm cov ducts khaws cia, ntxiv dag zog rau cov poov tshuaj. Kev txo qis hauv cov qib magnesium hauv cov cell inhibits Na + - K + - ATPase kev ua haujlwm thiab ua rau kom qhib cov kab mob extrarenal medullary potassium (ROMK), ua rau ntau cov poov tshuaj los ntawm lub raum. Kev sib cuam tshuam ntawm magnesium thiab potassium kuj tseem cuam tshuam rau kev ua kom cov sodium chloride co transporter (NCC), yog li txhawb nqa sodium reabsorption. Magnesium deficiency txo NCC abundance los ntawm E3 ubiquitin protein ligase hu ua NEDD4-2, uas downregulates neuronal precursor cell kev loj hlob, thiab tiv thaiv NCC activation los ntawm hypokalemia. Kev tsis tu ncua ntawm NCC tuaj yeem txhim kho qhov distal Na + kev thauj mus los hauv hypomagnesemia, ua rau muaj zog tso zis ntau ntxiv thiab hypokalemia.
Hypocalcemia kuj tshwm sim hauv cov neeg mob hypomagnesemia. Magnesium deficiency tuaj yeem cuam tshuam qhov tso tawm ntawm cov tshuaj parathyroid (PTH) thiab txo qhov rhiab heev ntawm ob lub raum mus rau PTH. Kev txo qis hauv PTH tuaj yeem txo qis rau lub raum calcium reabsorption, nce calcium hauv cov zis, thiab thaum kawg ua rau hypocalcemia. Vim hypocalcemia tshwm sim los ntawm hypomagnesemia, hypoparathyroidism feem ntau nyuaj kho tshwj tsis yog cov ntshav magnesium qib rov qab mus rau qhov qub.
Serum tag nrho magnesium ntsuas yog tus txheej txheem rau kev txiav txim siab magnesium ntsiab lus hauv kev kho mob. Nws tuaj yeem ntsuas qhov hloov pauv luv luv hauv cov ntsiab lus magnesium, tab sis tuaj yeem kwv yees tag nrho cov ntsiab lus magnesium hauv lub cev. Endogenous yam (xws li hypoalbuminemia) thiab exogenous yam (xws li cov qauv hemolysis thiab anticoagulants, xws li EDTA) tuaj yeem cuam tshuam qhov ntsuas ntawm magnesium, thiab cov xwm txheej no yuav tsum tau txiav txim siab thaum txhais cov txiaj ntsig kuaj ntshav. Serum ionized magnesium kuj tuaj yeem ntsuas tau, tab sis nws qhov kev siv tshuaj kho mob tseem tsis tau meej.
Thaum kuaj xyuas hypomagnesemia, qhov ua rau feem ntau tuaj yeem txiav txim siab raws li tus neeg mob keeb kwm kho mob. Txawm li cas los xij, yog tias tsis muaj qhov laj thawj meej meej, cov kev kuaj mob tshwj xeeb yuav tsum tau siv los txiav txim siab seb magnesium poob yog tshwm sim los ntawm lub raum lossis plab hnyuv, xws li 24-teev magnesium excretion, magnesium excretion feem, thiab magnesium load test.
Cov tshuaj Magnesium yog lub hauv paus rau kev kho mob hypomagnesemia. Txawm li cas los xij, tam sim no tsis muaj cov lus qhia meej txog kev kho mob hypomagnesemia; Yog li, txoj kev kho mob feem ntau yog nyob ntawm qhov mob hnyav ntawm cov tsos mob. Me me hypomagnesemia tuaj yeem kho nrog cov tshuaj hauv qhov ncauj. Muaj ntau cov tshuaj magnesium npaj nyob rau hauv kev ua lag luam, txhua tus muaj qhov sib txawv ntawm qhov nqus. Organic ntsev (xws li magnesium citrate, magnesium aspartate, magnesium glycine, magnesium gluconate, thiab magnesium lactate) tau yooj yim nqus los ntawm tib neeg lub cev dua li cov ntsev inorganic (xws li magnesium chloride, magnesium carbonate, thiab magnesium oxide). Cov kev mob tshwm sim feem ntau ntawm cov tshuaj magnesium hauv qhov ncauj yog raws plab, uas ua rau muaj kev sib tw rau qhov ncauj magnesium ntxiv.
Rau cov neeg mob refractory, kev kho tshuaj ntxiv yuav tsim nyog. Rau cov neeg mob uas muaj lub raum ua haujlwm zoo, inhibiting epithelial sodium channels nrog aminophenidate lossis triaminophenidate tuaj yeem ua rau cov ntshav magnesium nce ntxiv. Lwm cov tswv yim muaj peev xwm suav nrog kev siv SGLT2 inhibitors kom nce qib magnesium hauv cov ntshav, tshwj xeeb tshaj yog cov neeg mob ntshav qab zib. Cov txheej txheem tom qab cov teebmeem no tseem tsis tau meej meej, tab sis lawv tuaj yeem cuam tshuam txog qhov txo qis hauv glomerular pom tus nqi thiab nce rau hauv lub raum tubular reabsorption. Rau cov neeg mob hypomagnesemia uas tsis muaj txiaj ntsig hauv qhov ncauj magnesium supplementation kho, xws li cov neeg uas muaj plab hnyuv loj, tes thiab ko taw qaug dab peg, lossis qaug dab peg, nrog rau cov neeg uas muaj hemodynamic instability tshwm sim los ntawm arrhythmia, hypokalemia, thiab hypocalcemia, yuav tsum tau siv cov tshuaj intravenous. Cov hypomagnesemia tshwm sim los ntawm PPI tuaj yeem txhim kho los ntawm kev tswj hwm qhov ncauj ntawm inulin, thiab nws cov txheej txheem yuav cuam tshuam nrog kev hloov hauv plab microbiota.
Magnesium yog ib qho tseem ceeb tab sis feem ntau overlooked electrolyte hauv kev kuaj mob thiab kev kho mob. Nws tsis tshua raug kuaj raws li cov pa electrolyte. Hypomagnesemia feem ntau tsis muaj tsos mob. Txawm hais tias qhov tseeb mechanism ntawm kev tswj hwm magnesium tshuav nyob rau hauv lub cev tseem tsis tau meej, kev vam meej tau ua nyob rau hauv txoj kev tshawb no ntawm cov txheej txheem ntawm lub raum txheej txheem magnesium. Ntau cov tshuaj tuaj yeem ua rau hypomagnesemia. Hypomagnesemia feem ntau tshwm sim hauv cov neeg mob hauv tsev kho mob thiab muaj kev pheej hmoo rau ICU nyob ntev. Hypomagnesemia yuav tsum tau kho nyob rau hauv daim ntawv ntawm cov organic ntsev npaj. Txawm hais tias tseem muaj ntau yam tsis meej uas yuav daws tau txog lub luag haujlwm ntawm magnesium hauv kev noj qab haus huv thiab kab mob, muaj ntau yam kev txhim kho hauv daim teb no, thiab cov kws kho mob yuav tsum tau them nyiaj ntau dua rau qhov tseem ceeb ntawm magnesium hauv cov tshuaj kho mob.
Post lub sij hawm: Jun-08-2024