nkhani

Sodium, potaziyamu, calcium, bicarbonate, ndi madzimadzi m'magazi ndi maziko osungira ntchito zathupi m'thupi. Pakhala pali kusowa kwa kafukufuku pa matenda a magnesium ion. Kumayambiriro kwa zaka za m'ma 1980, magnesium inkadziwika kuti "electrolyte yoiwalika". Ndi kupezeka kwa mayendedwe enieni a magnesium ndi zonyamula, komanso kumvetsetsa kwa kayendetsedwe ka thupi ndi mahomoni a magnesium homeostasis, kumvetsetsa kwa anthu za gawo la magnesium muzachipatala kukukulirakulira.

Magnesium ndiyofunikira pakugwira ntchito kwa ma cell komanso thanzi. Magnesium amapezeka mu mawonekedwe a Mg2 +, ndipo amapezeka m'maselo onse a zamoyo zonse, kuchokera ku zomera kupita ku zinyama zapamwamba. Magnesium ndi chinthu chofunikira paumoyo ndi moyo, chifukwa ndi gawo lofunikira la gwero lamphamvu lama cell ATP. Magnesium makamaka imatenga nawo gawo muzochitika zazikulu zama cell pomanga ma nucleotides ndikuwongolera ma enzyme. Zochita zonse za ATPase zimafuna Mg2 + - ATP, kuphatikiza machitidwe okhudzana ndi RNA ndi DNA. Magnesium ndi cofactor ya mazana a ma enzymatic reaction m'maselo. Kuphatikiza apo, magnesium imayang'aniranso glucose, lipid, ndi protein metabolism. Magnesium imaphatikizidwa pakuwongolera magwiridwe antchito a neuromuscular, kuwongolera kuthamanga kwa mtima, kamvekedwe ka mtima, katulutsidwe ka mahomoni, komanso kutulutsidwa kwa N-methyl-D-aspartate (NMDA) m'katikati mwa mitsempha. Magnesium ndiye mthenga wachiwiri wophatikizidwa ndi ma sign a intracellular ndi owongolera amtundu wa circadian rhythm omwe amawongolera kayimbidwe ka circadian kachitidwe kachilengedwe.

Pali pafupifupi 25 g ya magnesium m'thupi la munthu, makamaka yosungidwa m'mafupa ndi minofu yofewa. Magnesium ndi ion yofunikira kwambiri komanso yachiwiri yayikulu kwambiri pambuyo pa potaziyamu. M'maselo, 90% mpaka 95% ya magnesium imamangiriza ku ligands monga ATP, ADP, citrate, mapuloteni, ndi nucleic acids, pamene 1% mpaka 5% ya magnesium ya intracellular imakhalapo mwaulere. Mlingo wa magnesium waulere wa intracellular ndi 1.2-2.9 mg/dl (0.5-1.2 mmol/L), womwe ndi wofanana ndi ndende ya extracellular. Mu plasma, 30% ya magnesium yozungulira imamangiriza ku mapuloteni makamaka kudzera mumafuta aulere. Odwala omwe ali ndi mafuta ambiri aulere kwanthawi yayitali nthawi zambiri amakhala ndi kuchuluka kwa magnesium m'magazi, zomwe zimayenderana kwambiri ndi chiopsezo cha matenda amtima ndi metabolic. Kusintha kwamafuta amafuta aulere, komanso milingo ya EGF, insulin, ndi aldosterone, imatha kukhudza ma magnesium amagazi.

Pali zigawo zitatu zazikulu zoyendetsera magnesiamu: matumbo (owongolera mayamwidwe a magnesium), mafupa (kusunga magnesium mu mawonekedwe a hydroxyapatite), ndi impso (zowongolera kutuluka kwa magnesium mkodzo). Machitidwewa ndi ophatikizidwa komanso ogwirizana kwambiri, palimodzi kupanga matumbo a impso axis, omwe amachititsa kuyamwa, kusinthanitsa, ndi kutuluka kwa magnesium. Kusalinganika kwa kagayidwe ka magnesium kungayambitse zotsatira za pathological ndi physiological

Zakudya zokhala ndi magnesium zimaphatikizapo mbewu, nyemba, mtedza, ndi masamba obiriwira (magnesium ndiye gawo lalikulu la chlorophyll). Pafupifupi 30% mpaka 40% yazakudya za magnesium zimatengedwa m'matumbo. Mayamwidwe ambiri amapezeka m'matumbo ang'onoang'ono kudzera m'mayendedwe olumikizana ndi ma cell, njira yokhazikika yomwe imaphatikiza kulumikizana kolimba pakati pa maselo. Matumbo akuluakulu amatha kuyendetsa bwino kuyamwa kwa magnesium kudzera mu transcellular TRPM6 ndi TRPM7. Kusagwira ntchito kwa matumbo amtundu wa TRPM7 kungayambitse kuperewera kwakukulu kwa magnesium, zinc, ndi calcium, zomwe zimawononga kukula koyambirira ndi kupulumuka pambuyo pa kubadwa. Kutsekemera kwa Magnesium kumakhudzidwa ndi zinthu zosiyanasiyana, kuphatikizapo kudya kwa magnesium, pH mtengo wa m'mimba, mahomoni (monga estrogen, insulini, EGF, FGF23, ndi hormone ya parathyroid [PTH]), ndi gut microbiota.
Mu impso, aimpso tubules imayamwanso magnesiamu kudzera munjira zonse zakunja ndi mkati mwa cell. Mosiyana ndi ma ion ambiri monga sodium ndi calcium, pang'ono chabe (20%) ya magnesium imalowetsedwanso mu proximal tubules, pomwe ambiri (70%) a magnesium amalowetsedwanso mu loop ya Heinz. Mu ma proximal tubules ndi nthambi zowoneka bwino za loop ya Heinz, kubwezeretsedwa kwa magnesium kumayendetsedwa makamaka ndi ma gradient ndi kuthekera kwa membrane. Claudin 16 ndi Claudin 19 amapanga mayendedwe a magnesium m'nthambi zokhuthala za Heinz loop, pomwe Claudin 10b amathandizira kupanga mpweya wabwino wa intraluminal pama cell a epithelial, ndikuyendetsa magnesium ion reabsorption. Mu ma distal tubules, magnesium imayang'anira bwino kulowetsedwa kwa intracellular (5% ~ 10%) kupyolera mu TRPM6 ndi TRPM7 pa nsonga ya selo, potero amazindikira kutuluka kwa mkodzo kwa magnesium.
Magnesium ndi gawo lofunikira la mafupa, ndipo 60% ya magnesium m'thupi la munthu imasungidwa m'mafupa. Magnesium yosinthika m'mafupa imapereka nkhokwe zamphamvu zosungirako plasma physiological concentration. Magnesium imalimbikitsa mapangidwe a mafupa pokhudza ntchito ya osteoblasts ndi osteoclasts. Kuchulukitsa kudya kwa magnesium kumatha kukulitsa kuchuluka kwa mchere wamfupa, motero kumachepetsa chiopsezo cha fractures ndi osteoporosis pakukalamba. Magnesium ali ndi ntchito ziwiri pakukonza mafupa. Panthawi yovuta kwambiri ya kutupa, magnesium ikhoza kulimbikitsa kufotokozera kwa TRPM7 mu macrophages, kupanga cytokine yodalira magnesiamu, ndikulimbikitsa chitetezo chamthupi cha mapangidwe a mafupa. Pakukonzanso mochedwa siteji ya machiritso a mafupa, magnesium imatha kukhudza osteogenesis ndikuletsa mpweya wa hydroxyapatite. TRPM7 ndi magnesium nawonso amatenga nawo mbali mu ndondomeko ya calcification ya mitsempha mwa kulimbikitsa kusintha kwa mitsempha yosalala ya minofu ku osteogenic phenotype.

Kuchuluka kwa magnesium mu seramu mwa akulu ndi 1.7-2.4 mg/dl (0.7-1.0 mmol/L). Hypomagnesemia imatanthawuza kuchuluka kwa magnesium mu seramu pansi pa 1.7 mg/dl. Odwala ambiri omwe ali ndi borderline hypomagnesemia alibe zizindikiro zoonekeratu. Chifukwa cha kuthekera kwa kuperewera kwa magnesiamu kwa nthawi yayitali kwa odwala omwe ali ndi seramu ya magnesium yoposa 1.5 mg/dl (0.6 mmol/L), ena amati kukweza kutsika kwa hypomagnesemia. Komabe, mulingo uwu ukadali wotsutsana ndipo umafunikira kutsimikizika kwina kwachipatala. 3% ~ 10% ya anthu ambiri ali ndi hypomagnesemia, pomwe chiwopsezo cha odwala matenda a shuga amtundu wa 2 (10% ~ 30%) ndi odwala omwe ali m'chipatala (10% ~ 60%) ndi okwera, makamaka omwe ali mu chipinda cha odwala kwambiri (ICU), omwe chiwopsezo chawo chimaposa 65%. Kafukufuku wamagulu angapo awonetsa kuti hypomagnesemia imalumikizidwa ndi chiwopsezo chowonjezereka cha kufa kwa zifukwa zonse komanso kufa kwa matenda amtima.

Zizindikiro zachipatala za hypomagnesemia zimaphatikizapo zizindikiro zosadziwika monga kugona, kupweteka kwa minofu, kapena kufooka kwa minofu chifukwa cha kudya kosakwanira, kutayika kwa m'mimba, kuchepa kwa impso, kapena kugawanso kwa magnesium kuchokera kunja kupita mkati mwa maselo (Chithunzi 3B). Hypomagnesemia nthawi zambiri imakhala ndi zovuta zina zama electrolyte, kuphatikiza hypocalcemia, hypokalemia, ndi metabolic alkalosis. Chifukwa chake, hypomagnesemia ikhoza kunyalanyazidwa, makamaka m'malo ambiri azachipatala pomwe milingo ya magnesium m'magazi siyimayesedwa nthawi zonse. Pokhapokha mu hypomagnesemia yoopsa (serum magnesium <1.2 mg/dL [0.5 mmol/L]), zizindikiro monga chisangalalo chachilendo cha neuromuscular (kugunda kwa mkono, khunyu, ndi kunjenjemera), kusokonezeka kwamtima (arrhythmias ndi vasoconstriction), ndi matenda a metabolic (insulin kukana ndi cartilac). Hypomagnesemia imalumikizidwa ndi kuchuluka kwa anthu omwe amagonekedwa m'chipatala komanso kufa kwa anthu, makamaka akaphatikizidwa ndi hypokalemia, kuwonetsa kufunikira kwachipatala kwa magnesium.
Magnesium yomwe ili m'magazi imakhala yochepera 1%, kotero kuti magnesiamu m'magazi sangathe kuwonetsa zonse zomwe zili mu minofu. Kafukufuku wasonyeza kuti ngakhale kuchuluka kwa magnesiamu mu seramu ndikwabwinobwino, zomwe zili mu intracellular magnesium zitha kutha. Chifukwa chake, kungoganizira za magnesium yokha m'magazi popanda kuganizira za kudya kwa magnesiamu komanso kutaya mkodzo kungachepetse kuchepa kwa magnesium.

Odwala omwe ali ndi hypomagnesemia nthawi zambiri amakhala ndi hypokalemia. Hypokalemia yovuta nthawi zambiri imagwirizanitsidwa ndi kuchepa kwa magnesiamu, ndipo imatha kukonzedwa bwino pambuyo poti ma magnesium abwerera mwakale. Kuperewera kwa Magnesium kumatha kulimbikitsa katulutsidwe wa potaziyamu kuchokera kumayendedwe otolera, kukulitsa kutaya kwa potaziyamu. Kuchepa kwa magnesiamu ya intracellular imalepheretsa ntchito ya Na + - K + - ATPase ndikuwonjezera kutsegulidwa kwa njira za extrarenal medullary potassium (ROMK), zomwe zimapangitsa kuti potaziyamu iwonongeke kwambiri kuchokera ku impso. Kuyanjana pakati pa magnesium ndi potaziyamu kumaphatikizanso kuyambitsa sodium chloride co transporter (NCC), potero kulimbikitsa kuyambiranso kwa sodium. Kuperewera kwa Magnesium kumachepetsa kuchuluka kwa NCC kudzera mu E3 ubiquitin protein ligase yotchedwa NEDD4-2, yomwe imachepetsa chitukuko cha neuronal precursor cell, ndikuletsa kuyambitsa kwa NCC kudzera mu hypokalemia. Kuchepetsa kosalekeza kwa NCC kumatha kupititsa patsogolo kuyenda kwa distal Na+ mu hypomagnesemia, zomwe zimabweretsa kutulutsa kwa potaziyamu mkodzo ndi hypokalemia.

Hypocalcemia imapezekanso mwa odwala omwe ali ndi hypomagnesemia. Kuperewera kwa Magnesium kumatha kulepheretsa kutulutsa kwa hormone ya parathyroid (PTH) ndikuchepetsa chidwi cha impso ku PTH. Kutsika kwa milingo ya PTH kumatha kuchepetsa kuyamwa kwa calcium mu aimpso, kukulitsa katulutsidwe ka calcium mumkodzo, ndipo pamapeto pake kumayambitsa hypocalcemia. Chifukwa cha hypocalcemia yoyambitsidwa ndi hypomagnesemia, hypoparathyroidism nthawi zambiri imakhala yovuta kukonza pokhapokha ngati milingo ya magnesium m'magazi ibwerera mwakale.

Muyezo wathunthu wa magnesium mu seramu ndiyo njira yodziwika bwino yodziwira zomwe zili mu magnesium muzochita zamankhwala. Itha kuwunika mwachangu kusintha kwakanthawi kochepa kwa magnesiamu, koma ingachepetse kuchuluka kwa magnesium m'thupi. Zinthu zamkati (monga hypoalbuminemia) ndi zinthu zakunja (monga zitsanzo za hemolysis ndi anticoagulants, monga EDTA) zitha kukhudza kuchuluka kwa kuyeza kwa magnesiamu, ndipo izi ziyenera kuganiziridwa pomasulira zotsatira zoyezetsa magazi. Seramu ionized magnesium imathanso kuyezedwa, koma ntchito yake yachipatala sinadziwikebe.
Pozindikira hypomagnesemia, chomwe chimayambitsa matendawa nthawi zambiri chimatsimikiziridwa potengera mbiri yachipatala ya wodwalayo. Komabe, ngati palibe chifukwa chenichenicho, njira zenizeni zodziwira matenda ziyenera kugwiritsidwa ntchito kusiyanitsa ngati kutaya kwa magnesium kumayambitsidwa ndi impso kapena m'mimba, monga 24-hour magnesium excretion, magnesium excretion fraction, ndi magnesium load test.

Magnesium supplements ndi maziko ochizira hypomagnesemia. Komabe, pakali pano palibe malangizo omveka bwino a mankhwala a hypomagnesemia; Choncho, mankhwala njira makamaka zimadalira kuopsa kwa matenda zizindikiro. Hypomagnesemia yofatsa imatha kuthandizidwa ndi zowonjezera pakamwa. Pali zokonzekera zambiri za magnesium pamsika, iliyonse ili ndi mayamwidwe osiyanasiyana. Mchere wachilengedwe (monga magnesium citrate, magnesium aspartate, magnesium glycine, magnesium gluconate, ndi magnesium lactate) amatengedwa mosavuta ndi thupi la munthu kuposa mchere wa inorganic (monga magnesium chloride, magnesium carbonate, ndi magnesium oxide). Zotsatira zodziwika bwino za oral magnesium supplements ndi kutsekula m'mimba, komwe kumabweretsa vuto la oral magnesium supplementation.
Pa milandu yotsutsa, chithandizo chamankhwala adjuvant chingakhale chofunikira. Kwa odwala omwe ali ndi vuto la impso, kuletsa njira za epithelial sodium ndi aminophenidate kapena triaminophenidate kumatha kukulitsa milingo ya magnesium mu seramu. Njira zina zomwe zingatheke ndikugwiritsa ntchito SGLT2 inhibitors kuti muwonjezere kuchuluka kwa seramu ya magnesium, makamaka kwa odwala matenda a shuga. Njira zomwe zimayambitsa zotsatirazi sizikudziwika bwino, koma zikhoza kukhala zokhudzana ndi kuchepa kwa glomerular filtration rate komanso kuwonjezeka kwa renal tubular reabsorption. Kwa odwala omwe ali ndi hypomagnesemia omwe sagwira ntchito pakamwa magnesium supplementation therapy, monga omwe ali ndi matenda a matumbo aang'ono, kugwidwa kwa manja ndi mapazi, kapena khunyu, komanso omwe ali ndi vuto la hemodynamic lomwe limayambitsidwa ndi arrhythmia, hypokalemia, ndi hypocalcemia, chithandizo cha mtsempha chiyenera kugwiritsidwa ntchito. Hypomagnesemia yomwe imayambitsidwa ndi PPI imatha kupitilizidwa ndikuwongolera pakamwa kwa inulin, ndipo kachitidwe kake kangakhale kokhudzana ndi kusintha kwamatumbo a microbiota.

Magnesium ndi electrolyte yofunikira koma nthawi zambiri imanyalanyazidwa pakuzindikira komanso kuchiza. Simayesedwa kawirikawiri ngati electrolyte wamba. Hypomagnesemia nthawi zambiri imakhala yopanda zizindikiro. Ngakhale kuti njira yeniyeni yoyendetsera mphamvu ya magnesium m'thupi sichinadziwikebe, kupita patsogolo kwachitika pofufuza njira yomwe impso zimagwiritsa ntchito magnesium. Mankhwala ambiri amatha kuyambitsa hypomagnesemia. Hypomagnesemia ndiyofala pakati pa odwala omwe ali m'chipatala komanso chiwopsezo chokhala ndi ICU nthawi yayitali. Hypomagnesemia iyenera kukonzedwa mu mawonekedwe a kukonzekera mchere wa organic. Ngakhale kuti pali zinsinsi zambiri zomwe ziyenera kuthetsedwa ponena za ntchito ya magnesium mu thanzi ndi matenda, pakhala kupita patsogolo kochuluka pankhaniyi, ndipo madokotala azachipatala ayenera kumvetsera kwambiri kufunikira kwa magnesium muzachipatala.