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Sodium, potasium, calcium, bicarbonate, uye fluid balance muropa ndiyo hwaro hwekuchengetedza physiological mabasa mumuviri. Pakave nekushaikwa kwekutsvagisa nezve magnesium ion kusagadzikana. Kare kuma1980, magnesium yaizivikanwa se "electrolyte yakakanganwa". Nekuwanikwa kwemagnesium chaiyo chiteshi uye vatakuri, pamwe nekunzwisiswa kweiyo physiological uye hormonal regulation ye magnesium homeostasis, kunzwisisa kwevanhu nezvebasa re magnesium mukurapa kwekiriniki kuri kuramba kuchidzika.

Magnesium yakakosha kune cellular basa uye hutano. Magnesium inowanzovapo muchimiro cheMg2+, uye inowanikwa mumaseru ese ezvipenyu zvese, kubva kumiti kuenda kune yakakwirira inoyamwisa. Magnesium chinhu chakakosha kune hutano uye hupenyu, sezvo iri yakakosha cofactor yemaserura simba sosi ATP. Magnesium inonyanya kutora chikamu mune chikuru physiological maitiro emasero nekusunga kune nucleotides uye kudzora enzyme basa. Ese maitiro eATPase anoda Mg2 + - ATP, kusanganisira maitiro ane chekuita neRNA uye DNA mabasa. Magnesium icofactor yemazana ekuita enzymatic mumasero. Mukuwedzera, magnesium inogadzirisawo glucose, lipid, uye protein metabolism. Magnesium inobatanidzwa mukugadzirisa neuromuscular function, kudzora rhythm yemwoyo, vascular tone, hormone secretion, uye kusunungurwa kweN-methyl-D-aspartate (NMDA) mukati mehutano hwehutano. Magnesium ndiyo yechipiri mutumwa inobatanidzwa mukusaina intracellular uye regulator ye circadian rhythm genes inodzora circadian rhythm ye biological system.

Kune inenge 25 g ye magnesium mumuviri wemunhu, inonyanya kuchengetwa mumapfupa uye zvinyoro zvinyoro. Magnesium inokosha intracellular ion uye yechipiri yakakura intracellular cation mushure me potassium. Mumasero, 90% kusvika 95% ye magnesium inosunga kune ligands yakadai seATP, ADP, citrate, mapuroteni, uye nucleic acids, asi chete 1% kusvika 5% ye intracellular magnesium iripo mukusununguka fomu. Iko intracellular yakasununguka magnesium concentration ndeye 1.2-2.9 mg / dl (0.5-1.2 mmol / L), iyo yakafanana neyo extracellular concentration. Muplasma, 30% ye magnesium inotenderera inosunga kumapuroteni kunyanya kuburikidza nemahara emafuta acids. Varwere vane nguva yakareba yakakwirira yemahara fatty acids kazhinji vane yakaderera yeropa magnesium concentrations, iyo inversely yakaenzana nenjodzi yemoyo uye metabolic zvirwere. Shanduko mumahara emafuta acids, pamwe nemazinga eEGF, insulin, uye aldosterone, anogona kukanganisa mazinga eropa magnesium.

Kune matatu makuru anodzora nhengo dze magnesium: ura (unodzora kudya kwemagesium absorption), mapfupa (kuchengeta magnesium muchimiro chehydroxyapatite), uye itsvo (inogadzirisa urinary magnesium excretion). Aya masisitimu akabatanidzwa uye akanyatso kurongeka, pamwe chete achigadzira gut bone itsvo axis, inotarisira kutora, kuchinjana, uye kubuda kwemagnesium. Kusaenzana kwe magnesium metabolism inogona kutungamirira kune pathological and physiological results

Zvokudya zvakapfuma mu magnesium zvinosanganisira zviyo, bhinzi, nzungu, uye miriwo yakasvibira (magnesium ndiyo yakakosha chikamu chechlorophyll). Inenge 30% kusvika 40% yezvokudya zve magnesium inotorwa nemudumbu. Kunyura kwakawanda kunoitika mudumbu diki kuburikidza nekutakura kwe intercellular, muitiro wekuita unosanganisira kusangana kwakasimba pakati pemasero. Ura hukuru hunogona kunyatso gadzirisa kunyura kwe magnesium kuburikidza ne transcellular TRPM6 uye TRPM7. Kusashanda kwemudumbu TRPM7 gene kunogona kutungamirira kukushaya kwakanyanya mu magnesium, zinc, uye calcium, izvo zvinokanganisa kukura kwekutanga uye kurarama mushure mekuberekwa. Magnesium absorption inokonzerwa nezvinhu zvakasiyana-siyana, kusanganisira kudya kwemagnesium, intestinal pH value, mahomoni (akadai seestrogen, insulini, EGF, FGF23, uye parathyroid hormone [PTH]), uye gut microbiota.
Muitsvo, renal tubules rebsorb magnesium kuburikidza zvose extracellular uye intracellular nzira. Kusiyana neayoni mazhinji akadai sesodium uye calcium, ishoma chete (20%) ye magnesium inodzoreredzwa muproximal tubules, nepo iyo yakawanda (70%) ye magnesium inodzoserwa muHeinz loop. Mune proximal tubules uye matavi akaomesesa eiyo Heinz loop, magnesium reabsorption inonyanya kufambiswa neconcentration gradients uye membrane kugona. Claudin 16 naClaudin 19 vanoumba magnesium chiteshi mumatavi akakora eHeinz loop, nepo Claudin 10b inobatsira kuumba yakanaka intraluminal voltage pamasero epithelial, ichityaira magnesium ion reabsorption. Mune distal tubules, magnesium inonyatso gadzirisa intracellular reabsorption (5% ~ 10%) kuburikidza neTRPM6 uye TRPM7 pamucheto wesero, nokudaro inosarudza kupera kwekupedzisira urinary magnesium excretion.
Magnesium chinhu chakakosha chemapfupa, uye 60% ye magnesium mumuviri wemunhu inochengetwa mumapfupa. Iyo inochinjana magnesium mumapfupa inopa simba rekuchengetedza kuchengetedza plasma physiological concentrations. Magnesium inokurudzira kuumbwa kwemapfupa nekukanganisa basa re osteoblasts uye osteoclasts. Kuwedzera kudya kwe magnesium kunogona kuwedzera mapfupa emaminerari emukati, nekudaro kuderedza njodzi yekutyoka uye osteoporosis panguva yekukwegura. Magnesium ine basa rembiri mukugadzirisa mapfupa. Munguva yakaoma yekuputika, magnesium inogona kukurudzira kutaura kwe TRPM7 mu macrophages, magnesium inoenderana nekugadzirwa kwe cytokine, uye kukurudzira immune microenvironment yekuumbwa kwepfupa. Munguva yekupedzisira yekugadziridza nhanho yekupora kwemapfupa, magnesium inogona kukanganisa osteogenesis uye inhibit hydroxyapatite kunaya. TRPM7 uye magnesium inobatanidzwawo mukugadzirwa kwevascular calcification nekukurudzira kuchinja kwevascular smooth muscle masero kune osteogenic phenotype.

Yakajairika serum magnesium concentration muvakuru i1.7 ~ 2.4 mg/dl (0.7 ~ 1.0 mmol/L). Hypomagnesemia inoreva serum magnesium concentration iri pasi pe1.7 mg/dl. Vazhinji varwere vane borderline hypomagnesemia havana zviratidzo zviri pachena. Nekuda kwekugona kwenguva yakareba kushaikwa kwemagnesium muvarwere vane serum magnesium mazinga anopfuura 1.5 mg/dl (0.6 mmol/L), vamwe vanokurudzira kukwidza yakaderera chikumbaridzo che hypomagnesemia. Nekudaro, iyi nhanho ichiri kukakavara uye inoda kumwe kusimbiswa kwekiriniki. 3% ~ 10% yehuwandu hwevanhu vane hypomagnesemia, nepo huwandu hwehuwandu hwevarwere vane chirwere cheshuga chechipiri (10% ~ 30%) uye varwere vari muchipatara (10% ~ 60%) yakakwirira, kunyanya mune intensive care unit (ICU) varwere, vane chiitiko chinodarika 65%. Multiple cohort zvidzidzo zvakaratidza kuti hypomagnesemia inobatanidzwa nekuwedzera kwengozi yezvose-zvinokonzera kufa uye kufa kwechirwere chemoyo.

Zviratidzo zvekliniki zve hypomagnesemia zvinosanganisira zviratidzo zvisiri izvo zvakadai sokukotsira, kuputika kwemisungo, kana kushaya simba kwemhasuru kunokonzerwa nekusakwana kwekudya kwekudya, kuwedzera kurasikirwa kwepamuviri, kuderedza renal reabsorption, kana kugoverwa kwe magnesium kubva kunze kusvika mukati memasero (Mufananidzo 3B). Hypomagnesemia inowanzosangana nemamwe matambudziko e electrolyte, kusanganisira hypocalcemia, hypokalemia, uye metabolic alkalosis. Naizvozvo, hypomagnesemia inogona kufuratirwa, kunyanya munzvimbo zhinji dzekiriniki apo mazinga eropa magnesium haawanzo kuyerwa. Chete mune yakanyanya hypomagnesemia (serum magnesium <1.2 mg/dL [0.5 mmol/L]), zviratidzo zvakadai seabnormal neuromuscular excitability (wrist ankle spasms, pfari, uye kudedera), kusagadzikana kwemoyo (arrhythmias uye vasoconstriction), uye metabolic disorders (insulini kurwisa uye cartilac). Hypomagnesemia inobatanidza nekuwedzera kwechipatara uye kufa kwevanhu, kunyanya kana ichiperekedzwa ne hypokalemia, kuratidza kukosha kwekliniki ye magnesium.
Iyo magnesium yemukati muropa accounts isingasviki 1%, saka iyo yeropa magnesium yemukati haigone kuratidza nekuvimbika iyo yakazara magnesium yemukati munyama. Tsvagiridzo yakaratidza kuti kunyangwe iyo serum magnesium yakajairwa, iyo intracellular magnesium yemukati inogona kupera. Naizvozvo, kufunga nezve magnesium chete iri muropa pasina kufunga nezvekudya magnesium kudya uye kurasikirwa weti kunogona kurerutsa kushaikwa kwekiriniki yemagnesium.

Varwere vane hypomagnesemia vanowanzoona hypokalemia. Stubborn hypokalemia inowanzobatanidzwa nekushaya magnesium, uye inogona kungogadziriswa zvinobudirira mushure mekunge mazinga e magnesium adzokera kune zvakajairika. Kushaikwa kweMagnesium kunogona kukurudzira kuvharirwa kwe potassium kubva mumadhamu ekuunganidza, zvichiwedzera kuwedzera kurasikirwa kwe potassium. Kuderera mu intracellular magnesium levels inhibits Na + - K + - ATPase basa uye inowedzera kuvhurwa kwe extrarenal medullary potassium (ROMK) nzira, zvichiita kuti potassium yakawanda irasike kubva muitsvo. Kudyidzana pakati pe magnesium ne potassium kunosanganisirawo activating sodium chloride co transporter (NCC), nokudaro zvichisimudzira sodium reabsorption. Kushaikwa kweMagnesium kunoderedza kuwanda kweNCC kuburikidza neE3 ubiquitin protein ligase inonzi NEDD4-2, iyo inoderedza neuronal precursor cell development, uye inodzivirira NCC activation kuburikidza ne hypokalemia. Kuenderera mberi kuderedzwa kweNCC kunogona kukwidziridza distal Na + kutakura mu hypomagnesemia, zvichikonzera kuwedzera urinary potassium excretion uye hypokalemia.

Hypocalcemia inowanikwawo kune varwere vane hypomagnesemia. Kushaikwa kweMagnesium kunogona kutadzisa kuburitswa kweparathyroid hormone (PTH) uye kuderedza kunzwisiswa kweitsvo kuPTH. Kuderera kwemazinga ePTH kunogona kuderedza renal calcium reabsorption, kuwedzera urinary calcium excretion, uye pakupedzisira kutungamirira ku hypocalcemia. Nekuda kwe hypocalcemia inokonzerwa ne hypomagnesemia, hypoparathyroidism inowanzonetsa kugadzirisa kunze kwekunge mazinga eropa e magnesium adzokera kune zvakajairika.

Serum yakazara magnesium kuyerwa ndiyo yakajairwa nzira yekuona magnesium zvirimo mukiriniki maitiro. Inogona kukurumidza kuongorora shanduko yenguva pfupi muhuwandu hwe magnesium, asi inogona kurerutsa iyo yakazara magnesium yemukati mumuviri. Endogenous factor (senge hypoalbuminemia) uye exogenous zvinhu (semuenzaniso hemolysis uye anticoagulants, akadai EDTA) zvinogona kukanganisa kuyerwa kukosha magnesium, uye zvinhu izvi zvinoda kutariswa pakududzira ongororo ropa. Serum ionized magnesium inogona kuyerwa, asi kushanda kwayo kwekiriniki hakusati kwajeka.
Paunenge uchiongorora hypomagnesemia, chikonzero chinogona kazhinji kutsanangurwa zvichienderana nenhoroondo yekurapa kwemurwere. Zvisinei, kana pasina chikonzero chakajeka chechikonzero, nzira dzakananga dzekuongorora dzinoda kushandiswa kusiyanisa kana kurasikirwa kwemagnesium kunokonzerwa neitsvo kana gastrointestinal turakiti, zvakadai se24-hour magnesium excretion, magnesium excretion fraction, uye magnesium load test.

Magnesium supplements ndiyo hwaro hwekurapa hypomagnesemia. Zvisinei, pane ikozvino hapana nzira yakajeka yekurapa ye hypomagnesemia; Nokudaro, nzira yekurapa inonyanya kuenderana nekuoma kwezviratidzo zvekliniki. Mild hypomagnesemia inogona kurapwa nemuromo wekuwedzera. Kune akawanda magnesium gadziriro pamusika, imwe neimwe iine akasiyana absorption rates. Organic salt (senge magnesium citrate, magnesium aspartate, magnesium glycine, magnesium gluconate, uye magnesium lactate) inotorwa nyore nyore nemuviri wemunhu pane inorganic salts (senge magnesium chloride, magnesium carbonate, uye magnesium oxide). Iyo yakajairika mhedzisiro yeoral magnesium yekuwedzera ndeye manyoka, izvo zvinounza dambudziko remuromo magnesium supplementation.
Panyaya dzerefractory, adjuvant drug treatment inogona kudiwa. Kune varwere vane hunhu hweitsvo basa, inhibiting epithelial sodium migero ine aminophenidate kana triaminophenidate inogona kuwedzera serum magnesium mazinga. Dzimwe nzira dzingangodaro dzinosanganisira kushandiswa kweSGLT2 inhibitors kuwedzera serum magnesium mazinga, kunyanya kune varwere vane chirwere cheshuga. Nzira dziri shure kwemigumisiro iyi haisati yanyatsojeka, asi inogona kunge yakabatana nekuderera kwe glomerular filtration rate uye kuwedzera kwe renal tubular reabsorption. Kune varwere vane hypomagnesemia avo vasingakwanisi mumuromo magnesium supplementation therapy, sevaya vane chirwere chepfupi, ruoko uye tsoka, kana pfari, pamwe chete nevaya vane hemodynamic instability inokonzerwa nearrhythmia, hypokalemia, uye hypocalcemia, intravenous therapy inofanira kushandiswa. Iyo hypomagnesemia inokonzerwa nePPI inogona kuvandudzwa nemuromo wekutonga inulin, uye nzira yayo inogona kunge yakabatana nekuchinja kwegut microbiota.

Magnesium inokosha asi inowanzoregererwa electrolyte mukuongororwa kwekliniki uye kurapwa. Haiwanzo kuedzwa seyakajairwa electrolyte. Hypomagnesemia kazhinji haina zviratidzo. Kunyangwe iyo chaiyo nzira yekudzora magnesium chiyero mumuviri haisati yanyatsojeka, kufambira mberi kwakaitwa mukudzidza kwemaitiro ayo itsvo dzinogadzira magnesium. Mishonga yakawanda inogona kukonzera hypomagnesemia. Hypomagnesemia yakajairika pakati pevarwere vari muchipatara uye njodzi yekugara kwenguva refu ICU. Hypomagnesemia inofanira kugadziriswa nenzira yekugadzirira kwemunyu. Kunyangwe kuchine zvakawanda zvakavanzika zvinofanirwa kugadziriswa nezve basa re magnesium muhutano uye chirwere, kwave nekufambira mberi kwakawanda mundima iyi, uye vanachiremba vekiriniki vanofanirwa kubhadhara zvakanyanya kukosha kwe magnesium mukurapa kwekiriniki.