透析患者低镁血症研究进展

镁是人体多种过程的必需阳离子,对ATP的功能以及DNA和RNA的合成都至关重要,并且是300多种酶促反应的辅助因子。镁不仅在神经肌肉过程中起重要作用,还对矿物质骨代谢、三磷酸腺苷代谢、神经递质释放、血管张力、心律和血小板活化血栓形成等具有调节作用。肾脏在调节镁平衡中起主要作用,慢性肾脏病(chronic kidney disease,CKD)晚期患者,血浆镁浓度通常由于肾小球滤过减少而呈现高镁的趋势。因此,长期以来,透析患者的一般政策是避免镁负荷。然而低镁血症相对常见,特别是在重症监护病房中。低镁血症的患病率很高,但往往没有被发现。近5年,一些队列研究报道,较低的血清镁水平与血液透析患者的全因和心血管死亡风险增加有关,并且增加了多种疾病的风险,如2型糖尿病、高血压、动脉粥样硬化等。此外,许多研究证明镁补充剂或提高透析液镁浓度有有益效果,但需要进行更多的前瞻性研究来证实这些效应。尽管镁具有生理学重要性,但其临床重要性经常被低估。事实上,在大多数医学书籍中很少提到镁紊乱。在这篇综述中,将谈论透析患者镁情况、低镁血症的原因、低镁血症相关疾病以及透析患者低镁血症的治疗等内容,以期为后续研究及临床治疗提供参考。 

Research progress of low magnesium hemorrhage in dialysis patients

Magnesium(Mg) is an essential cationic for a variety of processes in the human body. It is critical to the function of ATP and the synthesis of DNA and RNA, and is an auxiliary factor for more than 300 enzymatic reactions. Magnesium not only plays an important role in neuromuscular processes, but also regulates mineral bone metabolism, adenosine triphosphate metabolism, neurotransmitter release, vascular tension, heart rhythm and platelet activating thrombosis. The kidney plays a major role in regulating magnesium balance, and the plasma magnesium concentration in patients with advanced chronic kidney disease(CKD) usually shows a high magnesium trend due to the decrease of glomerular filtration. Therefore, for a long time, the general policy of dialysis patients is to avoid magnesium load. However, hypomagnesemia is relatively common, especially in intensive care units, where the prevalence of low-magnesium disease is high, but is often undetected. For nearly 5 years, some cohort studies have reported that lower levels of serum magnesium are associated with an increased risk of total and cardiovascular death in hemodialysis patients, and increase the risk of a variety of diseases, such as type 2 diabetes, hypertension, atherosclerosis, etc. In addition, many studies have shown beneficial effects of magnesium supplements or increased magnesium concentrations in dialysis fluids, but more prospective studies are needed to confirm these effects. Although, magnesium is of physiological importance, its clinical importance is often underestimated. In fact, magnesium disorders are rarely mentioned in most medical books. In this review, we will discuss the causes of magnesium in dialysis patients, related diseases, and the treatment, in order to provide reference for follow-up research and clinical treatment.