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I-sodium, i-potassium, i-calcium, i-bicarbonate, kunye nokulinganisela kwamanzi egazini sisiseko sokugcina imisebenzi ye-physiological emzimbeni. Kubekho ukungabikho kophando malunga ne-magnesium ion disorder. Kwangoko ngeminyaka yee-1980, i-magnesium yaziwa ngokuba “yi-electrolyte elityelweyo”. Ngokufunyanwa kweendlela ezikhethekileyo ze-magnesium kunye nabathuthi, kunye nokuqonda ukulawulwa kwe-physiological kunye nehomoni ye-magnesium homeostasis, ukuqonda kwabantu ngendima ye-magnesium kumayeza ekliniki kuhlala kusiba nzulu.

I-Magnesium ibalulekile ekusebenzeni kweselula kunye nempilo. I-Magnesium ihlala ikhona ngohlobo lweMg2+, kwaye ikhona kuzo zonke iiseli zazo zonke izinto eziphilayo, ukusuka kwizityalo ukuya kwizilwanyana ezincancisayo eziphezulu. I-Magnesium yinto ebalulekileyo kwimpilo kunye nobomi, njengoko i-cofactor ebalulekileyo yomthombo wamandla eselula i-ATP. I-Magnesium ithatha inxaxheba ikakhulu kwiinkqubo ze-physiological eziphambili zeeseli ngokuzibophelela kwi-nucleotides kunye nokulawula umsebenzi we-enzyme. Zonke iimpendulo ze-ATPase zifuna i-Mg2 + - ATP, kuquka iimpendulo ezinxulumene ne-RNA kunye nemisebenzi ye-DNA. IMagnesium yicofactor yamakhulu ee-enzymatic reactions kwiiseli. Ukongeza, i-magnesium ilawula i-glucose, i-lipid, kunye neprotheni ye-metabolism. I-Magnesium ibandakanyeka ekulawuleni umsebenzi we-neuromuscular, ukulawula isigqi senhliziyo, ithoni ye-vascular, i-hormone secretion, kunye nokukhululwa kwe-N-methyl-D-aspartate (NMDA) kwinkqubo ye-nervous central. I-Magnesium sisithunywa sesibini esibandakanyekayo kwi-intracellular signaling kunye nomlawuli we-circadian rhythm genes ezilawula isigqi se-circadian se-biological systems.

Kukho malunga ne-25 g ye-magnesium emzimbeni womntu, ikakhulu egcinwe emathanjeni nakwizicubu ezithambileyo. I-Magnesium yi-ion ebalulekileyo ye-intracellular kunye neyesibini enkulu ye-intracellular cation emva kwe-potassium. Kwiiseli, i-90% ukuya kwi-95% ye-magnesium ibophelela kwii-ligands ezifana ne-ATP, i-ADP, i-citrate, iiprotheni, kunye ne-nucleic acids, ngelixa kuphela i-1% ukuya kwi-5% ye-intracellular magnesium ikhona kwifom yamahhala. I-intracellular free concentration ye-magnesium yi-1.2-2.9 mg / dl (0.5-1.2 mmol / L), efana ne-extracellular concentration. Kwiplasma, i-30% ye-magnesium ejikelezayo ibophelela kwiiprotheni ngokuyinhloko nge-fatty acids yamahhala. Izigulana ezinamazinga aphezulu exesha elide lee-asidi ezinamafutha asimahla zidla ngokuba noxinzelelo olusezantsi lwe-magnesium yegazi, ehambelana ngokungafaniyo nomngcipheko wentliziyo kunye nezifo ze-metabolic. Utshintsho kwi-fatty acids yamahhala, kunye namanqanaba e-EGF, i-insulin, kunye ne-aldosterone, inokuchaphazela amanqanaba egazi le-magnesium.

Kukho izitho ezintathu eziphambili zokulawula i-magnesium: amathumbu (ukulawula ukufunxwa kwe-magnesium ekudleni), amathambo (ukugcina i-magnesium ngendlela ye-hydroxyapatite), kunye nezintso (ukulawula ukukhutshwa kwe-magnesium ye-urinary). Ezi nkqubo zidityanisiwe kwaye zilungelelaniswe kakhulu, kunye zenza i-gut bone kidney axis, ejongene nokufunxa, ukutshintshiselana, kunye nokukhupha i-magnesium. Ukungalingani kwe-magnesium metabolism kunokukhokelela kwiziphumo ze-pathological kunye ne-physiological

Ukutya okutyebileyo kwi-magnesium kubandakanya iinkozo, iimbotyi, amantongomane, kunye nemifuno eluhlaza (i-magnesium yeyona nto iphambili ye-chlorophyll). Ngokumalunga ne-30% ukuya kwi-40% yokutya kwe-magnesium intake ifunxwa ngamathumbu. Uninzi lwe-absorption lwenzeka emathunjini amancinci ngokuthuthwa kwe-intercellular, inkqubo ye-passive ebandakanya ukudibanisa okuqinileyo phakathi kweeseli. Amathumbu amakhulu anokulawula ngokufanelekileyo ukuxutywa kwe-magnesium ngokusebenzisa i-transcellular TRPM6 kunye ne-TRPM7. Ukungasebenzi kwe-intestinal TRPM7 gene kunokubangela ukusilela okukhulu kwi-magnesium, i-zinc, kunye ne-calcium, eyonakalisa ukukhula kwangaphambili kunye nokuphila emva kokuzalwa. Ukufakwa kwe-Magnesium kuphenjelelwa zizinto ezahlukeneyo, kubandakanywa ukungena kwe-magnesium, ixabiso le-pH yamathumbu, i-hormone (efana ne-estrogen, i-insulin, i-EGF, i-FGF23, kunye ne-hormone ye-parathyroid [PTH]), kunye ne-gut microbiota.
Kwizintso, i-renal tubules iphinda ifake i-magnesium ngeendlela zombini ezingaphandle kunye ne-intracellular. Ngokungafaniyo ne-ion ezininzi ezifana ne-sodium kunye ne-calcium, kuphela inani elincinci (i-20%) ye-magnesium iphinda ifakwe kwi-tubules ehamba phambili, ngelixa ininzi (i-70%) ye-magnesium iphinda ifakwe kwi-loop ye-Heinz. Kwiiproximal tubules kunye namasebe arhabaxa e-Heinz loop, i-magnesium reabsorption iqhutywa ikakhulu yi-concentration gradients kunye ne-membrane enokubakho. UClaudin 16 kunye noClaudin 19 benza iitshaneli ze-magnesium kumasebe ashinyeneyo e-Heinz loop, ngelixa i-Claudin 10b inceda ukwenza i-voltage ye-intraluminal enhle kwiiseli ze-epithelial, iqhuba i-magnesium ion reabsorption. Kwii-tubules ezikude, i-magnesium ilawula kakuhle i-reabsorption ye-intracellular (5% ~ 10%) nge-TRPM6 kunye ne-TRPM7 kwi-tip yeseli, ngaloo ndlela imisela ukukhutshwa kwe-magnesium ye-urinary yokugqibela.
I-Magnesium yinto ebalulekileyo yamathambo, kwaye i-60% ye-magnesium emzimbeni womntu igcinwe emathanjeni. I-magnesium etshintshisayo emathanjeni ibonelela ngogcino oluguquguqukayo lokugcina i-plasma physiological concentrations. I-Magnesium ikhuthaza ukubunjwa kwamathambo ngokuchaphazela umsebenzi we-osteoblasts kunye ne-osteoclasts. Ukunyusa i-magnesium intake inokunyusa umxholo wamathambo amaminerali, ngaloo ndlela unciphisa umngcipheko wokuphuka kunye ne-osteoporosis ngexesha lokuguga. I-Magnesium inendima emibini ekulungiseni amathambo. Ngethuba lesigaba esinzima sokuvuvukala, i-magnesium inokukhuthaza ukubonakaliswa kwe-TRPM7 kwi-macrophages, ukuveliswa kwe-cytokine exhomekeke kwi-magnesium, kunye nokukhuthaza i-immune microenvironment yokwakheka kwamathambo. Ngexesha lokulungiswa kwexesha lokugqibela lokuphulukiswa kwamathambo, i-magnesium inokuchaphazela i-osteogenesis kwaye inhibit imvula ye-hydroxyapatite. I-TRPM7 kunye ne-magnesium nayo ithatha inxaxheba kwinkqubo yokubala i-vascular calcification ngokuchaphazela ukuguqulwa kweeseli ze-vascular smooth muscle kwi-osteogenic phenotype.

I-concentration ye-magnesium ye-serum eqhelekileyo kubantu abadala i-1.7 ~ 2.4 mg / dl (0.7 ~ 1.0 mmol / L). I-Hypomagnesemia ibhekisa kwi-serum magnesium concentration engaphantsi kwe-1.7 mg/dl. Uninzi lwezigulane ezine-borderline hypomagnesemia azinazo iimpawu ezicacileyo. Ngenxa yokuba nokwenzeka kwexesha elide lokunqongophala kwe-magnesium kwizigulane ezinamazinga e-serum magnesium angaphezu kwe-1.5 mg / dl (0.6 mmol / L), abanye bacebisa ukuphakamisa umda ophantsi we-hypomagnesemia. Nangona kunjalo, eli nqanaba lisaphikisana kwaye lifuna ukuqinisekiswa okungaphezulu kweklinikhi. I-3% ~ 10% yabemi ngokubanzi bane-hypomagnesemia, ngelixa izinga leziganeko zohlobo lwe-2 yesifo sikashukela (i-10% ~ 30%) kunye nezigulane ezibhedlele (10% ~ 60%) ziphezulu, ngakumbi kwi-intensive care unit (ICU) izigulane, ezinezinga leziganeko ezidlula i-65%. Uphononongo oluninzi lweqela lubonise ukuba i-hypomagnesemia inxulunyaniswa nomngcipheko owongezelelweyo wokufa okubangelwa zizinto zonke kunye nokufa okunxulumene nesifo senhliziyo.

Iimpawu zeklinikhi ze-hypomagnesemia ziquka iimpawu ezingezizo ezinjengokozela, ukuxhatshazwa kwemisipha, okanye ubuthathaka bemisipha obubangelwa ukungonelanga kokutya, ukunyuka kokulahlekelwa kwesisu, ukunciphisa ukubuyisela i-renal, okanye ukuhanjiswa kwakhona kwe-magnesium ukusuka ngaphandle ukuya ngaphakathi kweeseli (Umfanekiso 3B). I-Hypomagnesemia ihlala ihleli kunye nezinye iziphazamiso ze-electrolyte, kubandakanya i-hypocalcemia, i-hypokalemia, kunye ne-alkalosis ye-metabolic. Ngoko ke, i-hypomagnesemia inokungahoywa, ngakumbi kwiindawo ezininzi zeklinikhi apho amanqanaba e-magnesium yegazi ayilinganisi ngokuqhelekileyo. Kuphela kwi-hypomagnesemia enzima (i-serum magnesium <1.2 mg / dL [0.5 mmol / L]), iimpawu ezifana nokungaqhelekanga kwe-neuromuscular excitability (i-wrist ankle spasms, i-epilepsy, kunye nokungcangcazela), ukungahambi kakuhle kwe-cardiovascular (arrhythmias kunye ne-vasoconstriction), kunye nokuphazamiseka kwe-metabolic (i-insulin ukumelana ne-cartilac). I-Hypomagnesemia ihambelana nokunyuka kwezibhedlele kunye namazinga okufa, ngakumbi xa ihamba kunye ne-hypokalemia, ebonisa ukubaluleka kweklinikhi ye-magnesium.
Umxholo we-magnesium kwi-akhawunti yegazi ngaphantsi kwe-1%, ngoko umxholo we-magnesium wegazi awukwazi ukubonisa ngokuthembekileyo umxholo we-magnesium kwizicubu. Uphando luye lwabonisa ukuba nangona i-serum magnesium concentration iyinto eqhelekileyo, umxholo we-magnesium we-intracellular unokupheliswa. Ke ngoko, ukuqwalasela kuphela umxholo we-magnesium egazini ngaphandle kokuqwalasela ukutya kwe-magnesium kunye nokulahleka komchamo kunokujongela phantsi ukusilela kweklinikhi ye-magnesium.

Izigulane ezine-hypomagnesemia zihlala zifumana i-hypokalemia. I-hypokalemia enenkani idla ngokunxulunyaniswa nokunqongophala kwe-magnesium, kwaye inokulungiswa ngokufanelekileyo kuphela emva kokuba amanqanaba e-magnesium ebuyele kwisiqhelo. Ukunqongophala kwe-Magnesium kunokukhuthaza ukukhuselwa kwe-potassium kwimibhobho yokuqokelela, ukunyusa ukulahleka kwe-potassium. Ukunciphisa amanqanaba e-magnesium ye-intracellular kuvimbela umsebenzi we-Na + - K + - ATPase kwaye kwandisa ukuvulwa kweziteshi ze-extrarenal medullary potassium (ROMK), ezikhokelela ekulahlekeni kwe-potassium eninzi kwiintso. Ukusebenzisana phakathi kwe-magnesium kunye ne-potassium kukwabandakanya ukusebenzisa i-sodium chloride co transporter (NCC), ngaloo ndlela ikhuthaza ukubuyiswa kwakhona kwesodium. Ukunqongophala kwe-Magnesium kunciphisa ubuninzi be-NCC nge-E3 ubiquitin protein ligase ebizwa ngokuba yi-NEDD4-2, ethoba i-neuronal precursor cell development, kwaye ikhusela ukusebenza kwe-NCC nge-hypokalemia. Ukulawulwa ngokuqhubekayo kwe-NCC kunokuphucula i-distal Na + transport kwi-hypomagnesemia, ekhokelela ekwandeni kwe-urinary potassium excretion kunye ne-hypokalemia.

I-Hypocalcemia nayo ixhaphakile kwizigulane ezine-hypomagnesemia. Ukunqongophala kwe-Magnesium kunokuthintela ukukhululwa kwehomoni ye-parathyroid (PTH) kunye nokunciphisa uvakalelo lwezintso kwi-PTH. Ukuhla kumanqanaba e-PTH kunokunciphisa ukubuyiswa kwakhona kwe-renal calcium, ukwandisa ukukhutshwa kwe-calcium yomchamo, kwaye ekugqibeleni kukhokelele kwi-hypocalcemia. Ngenxa ye-hypocalcemia ebangelwa yi-hypomagnesemia, i-hypoparathyroidism idla ngokuba nzima ukuyilungisa ngaphandle kokuba amanqanaba egazi e-magnesium abuyele kwisiqhelo.

Umlinganiselo we-Magnesium yeSerum yindlela eqhelekileyo yokumisela umxholo we-magnesium kwinkqubo yonyango. Inokuvavanya ngokukhawuleza utshintsho lwexesha elifutshane kumxholo we-magnesium, kodwa inokuthi ijonge phantsi umxholo opheleleyo we-magnesium emzimbeni. Izinto ezingapheliyo (ezifana ne-hypoalbuminemia) kunye nezinto ezingaphandle (ezifana ne-specimen hemolysis kunye ne-anticoagulants, njenge-EDTA) inokuchaphazela ixabiso lomlinganiselo we-magnesium, kwaye ezi zinto kufuneka ziqwalaselwe xa kuchazwa iziphumo zovavanyo lwegazi. ISerum ionized magnesium nayo inokulinganiswa, kodwa ukusebenza kwayo kweklinikhi akukacaci.
Xa uxilonga i-hypomagnesemia, isizathu sinokumiselwa ngokuqhelekileyo ngokusekelwe kwimbali yonyango yesigulane. Nangona kunjalo, ukuba akukho sizathu esicacileyo esisisiseko, iindlela ezithile zokuxilonga kufuneka zisetyenziswe ukwahlula ukuba ilahleko ye-magnesium ibangelwa yintso okanye i-gastrointestinal tract, njenge-24-hour magnesium excretion, i-magnesium excretion fraction, kunye novavanyo lomthwalo we-magnesium.

Izongezelelo zeMagnesium zisisiseko sokunyanga i-hypomagnesemia. Nangona kunjalo, okwangoku akukho sikhokelo sonyango esicacileyo se-hypomagnesemia; Ngoko ke, indlela yonyango ikakhulu ixhomekeke kubunzima beempawu zeklinikhi. I-hypomagnesemia ethambileyo inokunyangwa ngezongezo zomlomo. Maninzi amalungiselelo e-magnesium kwimarike, ngalinye linamazinga ahlukeneyo okufunxa. Iityuwa ze-Organic (ezifana ne-magnesium citrate, i-magnesium aspartate, i-magnesium glycine, i-magnesium gluconate, kunye ne-magnesium lactate) zifunxwa lula ngumzimba womntu kune-inorganic salts (ezifana ne-magnesium chloride, i-magnesium carbonate, kunye ne-magnesium oxide). Umphumo oqhelekileyo wezongezelelo zomlomo we-magnesium urhudo, obangela umngeni wokuncedisa ngomlomo we-magnesium.
Kwiimeko eziphikisayo, unyango lwe-adjuvant drug lungafuneka. Kwizigulane ezinomsebenzi oqhelekileyo wezintso, ukuvimbela iziteshi ze-sodium epithelial kunye ne-aminophenidate okanye i-triaminophenidate kunokunyusa amanqanaba e-serum magnesium. Ezinye izicwangciso ezinokubakho ziquka ukusetyenziswa kwe-SGLT2 inhibitors ukunyusa amanqanaba e-serum magnesium, ngakumbi kwizigulane ezinesifo sikashukela. Iindlela ezingemva kwezi ziphumo azikacaci, kodwa zinokunxulumana nokuncipha kwesantya sokuhluza i-glomerular kunye nokunyuka kwe-renal tubular reabsorption. Kwizigulane ezine-hypomagnesemia ezingasebenziyo kwi-oral magnesium yonyango yonyango, njengabo banesifo esifutshane se-bowel syndrome, ukubanjwa kwezandla kunye nonyawo, okanye ukuxhuzula, kunye nalabo abane-hemodynamic instability ebangelwa yi-arrhythmia, hypokalemia, kunye ne-hypocalcemia, unyango lwe-intravenous kufuneka lusetyenziswe. I-hypomagnesemia ebangelwa yi-PPI inokuphuculwa ngokulawulwa komlomo we-inulin, kwaye indlela yayo inokuhambelana notshintsho kwi-gut microbiota.

I-Magnesium yi-electrolyte ebalulekileyo kodwa ihlala ingahoywa kuxilongo lwezonyango kunye nonyango. Ayifane ivavanywe njenge-electrolyte eqhelekileyo. I-Hypomagnesemia ngokuqhelekileyo ayinazo iimpawu. Nangona indlela echanekileyo yokulawula ukulinganisela kwe-magnesium emzimbeni ayikacaci, inkqubela yenziwe kwisifundo somatshini apho izintso ziqhuba i-magnesium. Amachiza amaninzi anokubangela i-hypomagnesemia. I-Hypomagnesemia ixhaphakile phakathi kwezigulana esibhedlele kunye nomngcipheko wokuhlala ixesha elide kwe-ICU. I-Hypomagnesemia kufuneka ilungiswe ngendlela yamalungiselelo etyuwa ephilayo. Nangona kusekho iimfihlakalo ezininzi eziza kusonjululwa malunga nendima ye-magnesium kwimpilo kunye nezifo, kukho inkqubela phambili eninzi kule ntsimi, kwaye oogqirha beklinikhi kufuneka bahlawule ngakumbi ukubaluleka kwe-magnesium kunyango lweklinikhi.