原发性甲状旁腺功能亢进症患者的血镁特点和临床意义

目的 回顾分析27例原发性甲状旁腺功能亢进症(PHPT)患者的血清镁浓度,了解其特点及临床意义.方法 收集1997年～2007年该院收治的PHPT患者27例.利用SPSS软件对血镁等临床资料进行统计分析.结果 PHPT患者入院时40.70%在低镁血症.与血镁正常的PHPT患者相比,低镁者血PTH水平和尿镁/尿钙比值显著增高,尿钙排出减少,骨骼受累明显增多.手术治疗的16例PHPT患者中,术前低镁者术后100%仍有低血镁,且术后血镁水平进一步降低,而术前血镁正常的患者中75%术后发生低镁血症.术前血镁水平不同的2组患者术后血钙磷的变化也存在显著不同.结论 PHPT伴发低镁血症并不少见.术前伴发低血镁提示PHPT的病情可能更严重.术后需通过积极监测血钙磷镁水平的变化来指导治疗.     

Gitelman综合征14例临床特征分析

目的:分析Gitelman综合征(GS)的临床特征,以提高该病的诊治水平?方法: 回顾性分析南京医科大学第一附属医院内分泌科近5年住院诊治的14例GS病例资料?结果:患者发病年龄13~54(32.9 ± 12.0)岁,男5例,女9例?病程最短为1个月,最长为15年?体质指数(BMI):(21.0 ± 2.9) kg/m2,收缩压:(109.6 ± 10.8) mmHg,舒张压(69.6 ± 6.7) mmHg?临床上以双下肢无力?发作性四肢软瘫?多饮?多尿?夜尿增加?手足抽搐等为主要表现?实验室检查均表现为低血钾?低血镁?低尿钙?高尿钾?代谢性碱中毒?卧立位试验结果显示:卧位及立位血浆肾素活性(PRA)?血管紧张素Ⅱ和醛固酮有不同程度升高?肾脏穿刺病理提示球旁器增生(3/4)?补钾补镁?联合安体舒通等药物治疗后症状缓解,但血钾(11/14)?血镁(10/14)未升至正常水平?结论: GS的临床特征包括:低血钾?低血镁?低尿钙?正常偏低血压以及高PRA?高血管紧张素Ⅱ?高醛固酮和高血气pH值,可以总结为“四低四高”?本病治疗以补钾补镁为主,可以联合应用醛固酮拮抗剂,一般预后良好?     

腹膜透析患者血镁水平及相关因素的分析

目的：调查单个腹膜透析中心腹透患者的血镁水平,并比较不同血镁水平间腹透患者的人口统计学、透析状况、生化指标的差异。方法：对本腹透中心147例患者的人口学特征以及临床、实验室数据进行回顾性研究。按血镁浓度将其分为A组：Mg2+<0.77 mmol/L,B组：0.77 mmol/L≤Mg2+≤1.03 mmol/L,C组：Mg2+>1.03 mmo/L。结果：A组血磷、钙、钾、尿素氮显著低于C组;B组血清白蛋白显著低于C组;A组血肌酐显著低于B和C组;B、C组尿素清除指数、标准化的肌酐清除率均显著低于A组;双变量相关性分析：血镁与血磷、钾、全段甲状旁腺激素呈正相关,而血镁与尿素清除指数、标准化的肌酐清除率呈负相关。另外,4种腹膜转运类型中,高转运组血镁浓度显著低于低平均转运组及低转运组（P < 0.01）。结论：腹透患者存在着镁代谢异常,其中高镁血症发生率高于低镁血症。腹膜的转运能力高、透析充分性好的患者血镁浓度可能越低,另外血镁异常经常伴随着其他电解质及代谢紊乱,高镁血症患者血钙、磷、钾浓度可能也较高,血糖水平可能较低。     

17例Gitelman综合征临床分析

目的分析Gitelman综合征的临床特点和实验室特点,进一步提高诊疗水平。方法对解放军总医院近5年来17例(男/女:11/6)患者进行回顾性研究,对其临床症状、实验室、影像学检查结果及诊治情况进行分析。结果 17例患者中15例均有不同程度的下肢乏力,其中软瘫8例;实验室检查表现为低血钾(17/17),低血镁(17/17)、低尿钙(17/17);血肾素活性(17/17)、血管紧张素Ⅱ(14/17)及醛固酮(7/17)明显升高;单纯补钾或联合消炎痛、安体舒通和门冬氨酸钾镁片等药物治疗后症状缓解,但血钾、血镁未升至正常水平。结论 Gitelman综合征以双下肢乏力为主要临床表现,并伴有低血钾、低血镁等,治疗应以补钾、补镁、醛固酮拮抗剂等多种药物联合应用,预后良好。     

镁离子在血液透析治疗中的价值及临床观察

观察了20例尿毒症维持性血液透析患者在其他成分浓度不变,而镁离子浓度改变的情况下的透析效果,发现用镁0.5 mmol/L透析液透析时病人血压升高,心率增快,手足抽搐伴低血镁、低血钾、低血钙。用镁为1.0 mmol/L时,血压、心率均有不同程度减低,但仍有手足抽搐伴高血镁、高血钾、低血钙。而用镁0.96 mmol/L心率血压变化不大,无手足抽搐。血镁、血钾、血钙均正常。     

男性糖耐量低减的骨密度分析

为探讨男性糖耐量低减者(IGT)患者骨密度(BMD)改变趋势及其相关机制。测定69例IGT患者(IGT—1组:n=32,餐后2小时血糖>7.8mmol/L、<9.4mmol/L;IGT—2组:n=37,餐后2小时血糖≥9.4mmol/L、<11.1mmol/L)及60例年龄相匹配的健康对照者股骨近端(Neck,Troch,ward三角)、正位腰椎(L(2～4))BMD、血钙(ca)、磷(P)、24小时尿钙(U—Ca)、尿磷(U—P)、晨尿ca/cr。结果对照组与IGT—1组、IGT—2组的血钙、磷、24小时尿钙、磷、Neck、Troch、ward、L(2～4)4个部位的BMD比较差异无显著(P>0.05)。IGT—1组与对照组尿Ca/Cr比较差异无显著意义(P>0.05),IGT—2组与对照组尿Ca/Cr比较明显高于对照组(P<0.05)。IGT—1组、IGT—2组与对照组BMD比较:Neck分别下降0.2%、2.8%;Troch分别下降0.5%、4.44%;Ward分别为:增加0.3%、下降1.5%;L(2～4)分别下降0.22%、0.2%;尿钙排出增加6.8%、13.8%。结果示IGT患者的Neck、Troch的BMD呈下降趋势。IGT患者骨量改变特点为:血糖升高,尿钙排出增加,骨吸收增加。     

低镁血症

<正> 镁是人体内重要的阳离子,在细胞外液中它次于钠、钾、钙,在细胞内液中仅次于钾。全身镁的总量的98％左右在细胞内及骨骼内,仅1％在血浆中。镁在人体内对多种酶系统有激活作用,维持横纹肌神经肌肉及心肌的应激,对平滑肌有舒张解痉作用。正常血清镁为0.75～1.25mmol/L(1.5～2.5mEq/L)。如血清镁小于0.75mmol/L(<1.5mEq/L),或24小时尿镁排出量小于1.5mmol/L(<3mEq/L)可确诊为低镁血症。     

L—门冬氨酸钾镁治疗肺心病顽固性心衰的疗效观察

肺心病顽固性心衰的治疗,一直是临床的难题。文献报道,低镁与心衰有密切的关系,故我们于1988年12月～1993年3月观察了40例肺心病顽固性心衰病人的血清镁浓度,并对其中20例采用L一门冬氨酸钾镁治疗,获得了明显疗效。现报告如下: 对象和方法 一、对象:按1977年全国第二次肺心病会议诊断标准,确诊为肺心病顽固性心衰病人40例。男30例,女10例。年龄42～70岁,平均54岁,40例血清镁除1例正常(1.23mmol/L),其余39例均于正常值(<0.8mmol/L),中合并低钾(<3.5mmol/L)34例,血镁,血钾均正     

17例Gitelman综合征临床分析

摘要：目的分析Gitelman综合征的临床特点和实验室特点,进一步提高诊疗水平。方法对解放军总医院近5年来17例（男/女：
11/6）患者进行回顾性研究,对其临床症状、实验室、影像学检查结果及诊治情况进行分析。结果17例患者中15例均有不同程
度的下肢乏力,其中软瘫8例;实验室检查表现为低血钾(17/17),低血镁(17/17)、低尿钙(17/17);血肾素活性(17/17)、血管紧张素
Ⅱ(14/17)及醛固酮(7/17)明显升高;单纯补钾或联合消炎痛、安体舒通和门冬氨酸钾镁片等药物治疗后症状缓解,但血钾、血镁
未升至正常水平。结论Gitelman综合征以双下肢乏力为主要临床表现,并伴有低血钾、低血镁等,治疗应以补钾、补镁、醛固酮
拮抗剂等多种药物联合应用,预后良好。
     

儿童特发性高钙尿症12例临床分析

12例特发性高钙尿症,男8例,女4例;发病年龄2.6～11.6岁。临床主要表现为无症状性血尿,不伴显著蛋白尿,尿钙/肌酐比值均大于0.23,24h尿钙定量>0.12mmol/kg,血钙正常。给予多饮水,适当限制高钙饮食,双氢克尿噻口服治疗,7例血尿消失,化验检查正常,3例无效,2例失访。     

Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men.

OBJECTIVE--To investigate the patterns of electrolyte abnormalities resulting from thiazide administration and whether they cause ventricular arrhythmias, and to help resolve the controversy over whether clinicians should routinely prescribe potassium-conserving therapy to all patients treated with thiazides. DESIGN--Double-blind, randomized controlled trial. PARTICIPANTS--A total of 233 hypertensive men aged 35 to 70 years. INTERVENTIONS--Participants were withdrawn from prior diuretic treatment and were replenished with oral potassium chloride and magnesium oxide. They were then randomized to 2 months of treatment with (1) hydrochlorothiazide; (2) hydrochlorothiazide with oral potassium; (3) hydrochlorothiazide with oral potassium and magnesium; (4) hydrochlorothiazide and triamterene; (5) chlorthalidone; or (6) placebo. MAIN OUTCOME MEASURES--Ventricular arrhythmias on 24-hour Holter monitoring and serum and intracellular potassium and magnesium levels. RESULTS--Of the 233 participants, 212 (91%) completed the study. Serum potassium levels were 0.4 mmol/L lower in the hydrochlorothiazide group than in the placebo group (P less than 0.01), and this mean difference was not affected by supplementation with potassium, with potassium and magnesium, or with triamterene. However, the supplements did prevent the occasional occurrence of marked hypokalemia; all 12 of the men who developed serum potassium levels of 3.0 mmol/L or less were among the 90 who received diuretics without supplementation (P less than 0.01). Similarly, the overall proportion of men with ventricular arrhythmias was not affected by randomized treatment, but there was a twofold increase in the proportion with arrhythmias among the 12 men with serum potassium levels of 3.0 mmol/L or less (P = .02). Serum magnesium and intracellular potassium and magnesium levels were not reduced by hydrochlorothiazide, nor were they related to ventricular arrhythmias. CONCLUSIONS--In the majority of hypertensive patients, treatment with 50 mg/d of hydrochlorothiazide does not cause marked hypokalemia or ventricular arrhythmias. However, because some individuals will develop hypokalemia after starting diuretic therapy, serum potassium levels should be monitored and potassium-sparing strategies should be used when indicated.     

Hypokalemia during the treatment of arterial hypertension with diuretics.

In a study of 50 patients with uncomplicated arterial hypertension the administration of hydrochlorothiazide, 50 to 100 mg daily or every other day, with or without reserpine, 0.25 mg daily, resulted in a fall in the mean blood pressure from 182/113 to 144/92 mm Hg. The mean duration of therapy was 19 months. The mean serum potassium concentration was 4.3 mmol/l before the onset of therapy. It fell during the first 6 weeks of treatment, but seldom below 3.5 mmol/l, then rose gradually and spontaneously to 4.1 mmol/l after 19 months of therapy. All the patients remained asymptomatic. These findings bring into question the routine use of potassium supplements or a potassium-sparing diuretic, such as spironolactone or triamterene, during the treatment of hypertension with diuretics such as the thiazides. The use of potassium supplements or a potassium-sparing agent may induce hyperkalemia in spite of the simultaneous administration of a diuretic that acts more proximally. Since hyperkalemia is potentially lethal, the serum potassium concentration should be carefully monitored in any patient receiving potassium supplements or a potassium-sparing agent.     

A study of plasma sodium levels in elderly people taking amiloride or triamterene in combination with hydrochlorothiazide.

This study was performed to compare the effect of one month''s treatment with hydrochlorothiazide (25 mg) in combination with either amiloride (2.5 mg) or triamterene (50 mg) on plasma sodium levels in elderly people in institutional care. Fifty residents of NHS nursing or social service residential care established on diuretics for congestive cardiac failure and aged 64 years or over were recruited. Forty-one patients were included in the final data analysis. Patients on hydrochlorothiazide/amiloride had a significantly lower plasma sodium (137 vs 139 mmol/l, 95% confidence interval for difference between medians 0-2 mmol/l) than those on hydrochlorthiazide/triamterene (P = 0.01). In equivalent potassium-retaining doses, amiloride is associated with significantly lower plasma sodium levels than triamterene, when given in combination with hydrochlorothiazide in elderly patients with congestive cardiac failure. This finding adds weight to uncontrolled observations implicating thiazide/amiloride diuretic combinations in causing serious hyponatraemia. This danger, although uncommon, should perhaps influence prescribing habits in an at-risk population.     

Treatment of arterial hypertension with tienilic acid, a new diuretic with uricosuric properties.

Tienilic acid--2,3-dichloro-4-(2-thienyl-carbonyl)phenoxyacetic acid--is a new diuretic with uricosuric properties. Nineteen patients with moderate arterial hypertension were treated for 5 consecutive weeks in a randomized fashion in a double-blind study with either tienilic acid or hydrochlorothiazide. Blood pressure was significantly reduced and to the same degree with both drugs. In 7 of the 11 patients receiving tienilic acid the daily dose was increased from 250 to 500 mg after 2 weeks, and in 2 of the 8 patients taking hydrochlorothiazide the daily dose was increased from 50 to 100 mg. Because of the potent uricosuric action of tienilic acid the mean serum urate concentration decreased from 6.3 to 3.3 mg/dL in the patients taking the drug. In contrast, the patients receiving hydrochlorothiazide the mean serum urate concentration increased from 6.1 to 7.8 mg/dL. Moderate hypokalemia of almost identical degree (mean serum potassium values 3.6 and 3.5 mmol/L) and mild metabolic alkalosis were observed in both groups. Tienilic acid had a marked hypocalciuric effect, which was of the same magnitude as the observed with hydrochlorothiazide. During the 5 weeks of treatment no significant change in renal or liver function was observed in either group. There were no hematologic complications and the drug was remarkably well tolerated. Tienilic acid, because of its unique character as a diuretic, hypouricemic and antihypertensive agent, should become the preferred drug for the treatment of arterial hypertension.     

Lithium toxicity induced by triamterene-hydrochlorothiazide.

Two patients on long-term lithium therapy for manic-depressive psychosis developed serious toxicity within days of being prescribed a combination of triamterene (50 mg) and hydrochlorothiazide (25 mg) for mild symptomless hypertension. Reduced clearance of lithium has been reported to follow its concurrent administration with diuretics that deplete both sodium and potassium. A combination of triamterene with thiazide has not been shown previously to precipitate lithium toxicity.     

Hypomagnesaemia and hypocalcaemia in a patient with ovarian carcinoma.

A patient with disseminated ovarian carcinoma presented with symptoms of hypocalcaemia secondary to hypomagnesaemia. The low serum magnesium (0.4 mmol/l) appeared to be due to renal leakage with no evidence of ureteric obstruction or hydronephrosis on intravenous urogram. Parathyroid hormone activity (serum levels and cAMP response) was normal, despite hypomagnesaemia. The patient''s complaints resolved after magnesium and calcium supplementation. Hypomagnesaemia of malignancy is a rare but important complication, and is both poorly recognized and understood.     

Glucose intolerance during diuretic therapy in elderly hypertensive patients. A second report from the European Working Party on high blood pressure in the elderly (EWPHE)

Five hundred and seven elderly hypertensive patients were followed for 1 year, 371 for 2 years and 270 for 3 years in a double-blind, randomized, controlled trial in which they received either placebo or 25-50 mg hydrochlorothiazide and 50-100 mg of triamterene daily. One third of the active treatment group also received 250 mg to 2 g methyldopa daily. After 1 year the active treatment group had an average increase in fasting blood sugar of 2.5 mg/dl compared with an average fall of 1.4 mg/dl in the placebo group (P = 0.01). The increase in blood sugar 1 hour and 2 hours after 50 g oral glucose tended to be greater in the actively treated group but these increases did not achieve statistical significance. The effects of diuretic treatment were established after one year and did not increase further over the next 2 years. Overall there was an increase in fasting blood sugar of 5 mg/dl in the active treatment group which occurred mainly in the first year. The hyperglycaemic effect of diuretics appeared to be partly or wholly related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom serum potassium decreased. The measures of blood sugar were also positively related to systolic pressure before and after treatment.     

血清电解质钠、钾、镁、钙离子正确度验证物质的定值及应用

目的 对血清电解质钠(Na)、钾(K)、镁(Mg)、钙(Ca)正确度验证物质应用离子色谱参考方法准确定值,并用于北京市临检中心正确度验证。方法 应用建立的离子色谱参考方法,对已研制的3个浓度水平的(批号为BCCL01、BCCL02和BCCL03)人血清基质电解质正确度验证物质进行定值,采用美国国家标准与技术研究院(National Institute of Standards and Technology, NIST)电解质标准参考物质(standard reference material, SRM) SRM 919b、SRM 918b、SRM 929a和SRM 915b进行量值传递。将NIST电解质标准物质配制5个浓度水平的钠、钾、镁、钙复合离子标准溶液,并建立标准曲线,对低、中、高3个水平正确度验证物质进行定值,计算相应不确定度。应用此物质在北京地区23家实验室开展正确度验证计划,正确度验证样本由北京市临床检验中心发放并按时统计汇报结果。依据美国临床实验室标准化协会(Clinical Laboratory Standards Institute,CLSI) EP-17A2,采用协方差的模型和Westgard模型来估算实验室总误差。结果 3个批号血清电解质正确度验证物质定值结果钠为125.6～159.1 mmol/L,钾为6.134～3.027 mmol/L,镁为1.389～0.539 mmol/L,钙为3.083～2.197 mmol/L。Westgard模型与参加实验室100%通过率结果相近,而协方差模型结果仅与60%通过率结果相近。结论 本研究应用准确可靠的离子色谱参考方法为电解质钠、钾、镁、钙正确度验证物质定值,可用于评价临床实验室4种阳离子常规检测方法的准确性。应用Westgard模型估算相比于协方差模型更能反映实验室的检测水平,所以推荐临床实验室在测定血清阳离子时使用Westgard模型估算总误差。     

Study of serum electrolytes in pregnancy induced hypertension

Hypertension complicating pregnancy is an important cause of foetal and maternal mortality and morbidity. Serum sodium, potassium, calcium and magnesium were evaluated in cases with gestational hypertension and pre-eclampsia and compared with normotensive pregnant women of corresponding period of gestation. Taking urinary micro-albumin creatinine ratio as standard to predict pregnancy induced hypertension, the role of serum electrolytes to predict the same was studied. A total of 200 patients were evaluated. There were no change in serum sodium and potassium in gestational hypertensive cases as well as in pre-eclamptic cases when compared with control group. Similar results were obtained when serum calcium level was evaluated. Mean serum magnesium level (1.53 +/- 0.29 mg/dl) was significantly low in cases of pre-eclampsia, while it was 1.79 +/- 0.25 mg/dl in patients with gestational hypertension and 2.19 +/- 0.2 mg/dl in control group. Patients having gestational hypertension along with increased micro-albumin creatinine ratio had significantly low mean magnesium level (1.68 +/- 0.1 mg/dl) when compared with gestational hypertensive patients with normal microalbumin creatinine ratio (serum magnesium level 1.87 +/- 0.1 mg/dl).     

Hypomagnesemia after major abdominal operations in cancer patients: clinical implications

BACKGROUND: Serum magnesium levels are rarely measured in routine chemistry panels. The extent and impact of postoperative serum magnesium changes remain unclear. METHODS: One hundred seventy-one cancer patients who had undergone celiotomy procedures during a 38-month period were evaluated retrospectively for postoperative electrolyte alterations, with special emphasis on serum magnesium. Clinicopathologic predictors and early postoperative outcome correlations were examined. RESULTS: There were 151 major procedures and 20 minor operations. All postoperative electrolyte and hematocrit values were significantly different from preoperative values, except for serum phosphate. Preoperative total serum magnesium (normal range: 1.7-2.5 mg/dL {0.7-1.03 mmol/L}), obtained prior to any bowel cleansing, differed from postoperative levels (means +/- standard deviation: 2.0 +/- 0.46 vs. 1.53 +/- 0.33 mg/dL; p < 0.0001). A lowered postoperative serum magnesium was observed in those patients who had either undergone an operation with curative intent (p = 0.0035), a major resection (vs. no resection, p = 0.0259), or preoperative bowel cleansing with sodium phosphate (p = 0.024). Other laboratory serum parameters that correlated with the postoperative magnesium level included postoperative levels of phosphate (p = 0.009), potassium (p = 0.01), and total calcium (p = 0.012), as well as preoperative calcium (p = 0.017). The complication rate was 20%, with five postoperative deaths (2.9%). Postoperative morbidity was predicted by preoperative potassium (p = 0.004) and albumin levels (p = 0.016); deaths were predicted by postoperative infections (p = 0.0007) and correlated to postoperative hypokalemia (p = 0.03). CONCLUSIONS: Major abdominal cancer operations lead to significant electrolyte alterations. The severity of these changes correlates with the resection extent, especially in procedures with curative intent. In addition, bowel cleansing with sodium phosphate may participate in lowering serum magnesium as well as other electrolytes. In light of our postoperative magnesium replacement policy, no untoward events could be linked to postoperative hypomagnesemia in this series. To evaluate the impact of postoperative hypomagnesemia or magnesium replacement on postoperative outcomes requires a prospective randomized trial.