izindaba

I-sodium, i-potassium, i-calcium, i-bicarbonate, nebhalansi yoketshezi egazini kuyisisekelo sokugcina imisebenzi yomzimba emzimbeni. Kube nokuntuleka kocwaningo nge-magnesium ion disorder. Kusukela ngawo-1980, i-magnesium yaziwa ngokuthi "i-electrolyte ekhohliwe". Ngokutholakala kweziteshi ezithize ze-magnesium nabathuthi, kanye nokuqonda ukulawulwa kwe-physiological kanye ne-hormonal ye-magnesium homeostasis, ukuqonda kwabantu ngendima ye-magnesium emithini yomtholampilo kuhlale kujula.

I-Magnesium ibalulekile ekusebenzeni kwamangqamuzana nempilo. I-Magnesium ivamise ukuba khona ngendlela ye-Mg2+, futhi ikhona kuwo wonke amangqamuzana azo zonke izinto eziphilayo, kusukela ezitshalweni kuya ezilwaneni ezincelisayo eziphakeme. I-Magnesium iyisici esibalulekile empilweni nempilo, njengoba iyi-cofactor ebalulekile yomthombo wamandla weselula i-ATP. I-Magnesium ibamba iqhaza kakhulu ezinqubweni eziyinhloko zomzimba wamaseli ngokubopha kuma-nucleotide nokulawula umsebenzi we-enzyme. Konke ukusabela kwe-ATPase kudinga i-Mg2+- ATP, okuhlanganisa ukusabela okuhlobene ne-RNA nemisebenzi ye-DNA. I-Magnesium iyi-cofactor yamakhulu okusabela kwe-enzymatic kumaseli. Ngaphezu kwalokho, i-magnesium iphinde ilawule i-glucose, i-lipid, kanye namaprotheni metabolism. I-Magnesium ihilelekile ekulawuleni ukusebenza kwe-neuromuscular, ukulawula isigqi senhliziyo, ithoni ye-vascular, secretion ye-hormone, nokukhululwa kwe-N-methyl-D-aspartate (NMDA) ohlelweni lwezinzwa oluphakathi. I-Magnesium iyisithunywa sesibili esibandakanyeka ekusayineni kwe-intracellular kanye nomlawuli wezakhi zofuzo zesigqi se-circadian ezilawula isigqi se-circadian sezinhlelo zebhayoloji.

Kukhona cishe i-25 g ye-magnesium emzimbeni womuntu, ikakhulukazi egcinwe emathanjeni nasezicutshini ezithambile. I-Magnesium iyi-ion ebalulekile ye-intracellular kanye nesibili esikhulu se-intracellular cation ngemva kwe-potassium. Emaseli, i-90% kuya ku-95% ye-magnesium ibophezela kuma-ligands afana ne-ATP, i-ADP, i-citrate, amaprotheni, nama-nucleic acid, kuyilapho kuphela i-1% kuya ku-5% ye-magnesium ye-intracellular ekhona ngendlela yamahhala. I-intracellular magnesium concentration yamahhala ingu-1.2-2.9 mg/dl (0.5-1.2 mmol/L), okufana nokuhlushwa okungaphandle kweseli. Ku-plasma, u-30% we-magnesium ejikelezayo ubopha amaprotheni ikakhulukazi ngama-fatty acids amahhala. Iziguli ezinamazinga aphezulu esikhathi eside wamafutha amahhala ama-acids ngokuvamile anezinga eliphansi le-magnesium egazini, elilingana ngokuphambene nengozi yezifo zenhliziyo nemithambo yegazi. Izinguquko ku-fatty acids mahhala, kanye namazinga e-EGF, i-insulin, ne-aldosterone, zingathinta amazinga e-magnesium egazini.

Kunezitho ezintathu eziyinhloko zokulawula i-magnesium: amathumbu (ukulawula ukumuncwa kwe-magnesium ekudleni), amathambo (ukugcina i-magnesium ngesimo se-hydroxyapatite), nezinso (ukulawula ukuphuma kwe-magnesium yomchamo). Lezi zinhlelo zididiyelwe futhi zididiyelwe kakhulu, ndawonye zakha i-axis yezinso zethambo le-gut, enesibopho sokumuncwa, ukushintshaniswa, kanye nokukhipha i-magnesium. Ukungalingani kwe-magnesium metabolism kungaholela emiphumeleni ye-pathological and physiological

Ukudla okucebile nge-magnesium kufaka okusanhlamvu, ubhontshisi, amantongomane, nemifino eluhlaza (i-magnesium iyisici esiyinhloko se-chlorophyll). Cishe u-30% kuya ku-40% wokudla kwe-magnesium emunca amathumbu. Ukumuncwa okuningi kwenzeka emathunjini amancane ngokuthuthwa kwe-intercellular, inqubo engenzi lutho ehlanganisa ukuhlangana okuqinile phakathi kwamaseli. Amathumbu amakhulu angalawula kahle ukumuncwa kwe-magnesium ngokusebenzisa i-transcellular TRPM6 ne-TRPM7. Ukungasebenzi kwe-gene ye-TRPM7 yamathumbu kungaholela ekushiyekeni okukhulu kwe-magnesium, i-zinc, ne-calcium, eyingozi ekukhuleni kokuqala nokuphila ngemva kokuzalwa. Ukumuncwa kwe-Magnesium kuthonywa izici ezihlukahlukene, okuhlanganisa ukungenisa kwe-magnesium, inani le-pH yamathumbu, amahomoni (afana ne-estrogen, i-insulin, i-EGF, i-FGF23, ne-hormone ye-parathyroid [PTH]), kanye ne-gut microbiota.
Ezinsweni, amashubhu ezinso aphinda amunca i-magnesium kuzo zombili izindlela ezingaphandle kwamaseli kanye ne-intracellular. Ngokungafani nama-ion amaningi afana ne-sodium ne-calcium, inani elincane kuphela (20%) le-magnesium liphinde lifakwe kuma-proximal tubules, kuyilapho iningi (70%) le-magnesium liphinde lifakwe ku-Heinz loop. Kuma-proximal tubules kanye namagatsha amaholoholo we-Heinz loop, ukumuncwa kabusha kwe-magnesium kuqhutshwa ikakhulukazi ama-gradients okugxilisa ingqondo namandla e-membrane. U-Claudin 16 kanye no-Claudin 19 bakha iziteshi ze-magnesium emagatsheni aminyene e-Heinz loop, kuyilapho i-Claudin 10b isiza ukwakha i-voltage eqondile ye-intraluminal kuwo wonke amangqamuzana e-epithelial, eqhuba ukumuncwa kabusha kwe-magnesium ion. Kuma-distal tubules, i-magnesium ilawula kahle ukutholwa kabusha kwe-intracellular (5% ~ 10%) ngokusebenzisa i-TRPM6 ne-TRPM7 esiphundu seseli, ngaleyo ndlela inquma ukuphuma kokugcina kwe-magnesium ye-urinary.
I-Magnesium iyingxenye ebalulekile yamathambo, futhi i-60% ye-magnesium emzimbeni womuntu igcinwa emathanjeni. I-magnesium eshintshwayo emathanjeni inikeza izinqolobane eziguquguqukayo zokugcina ukugxila komzimba we-plasma. I-Magnesium ikhuthaza ukwakheka kwamathambo ngokuthinta umsebenzi wama-osteoblasts nama-osteoclasts. Ukwenyuka kwe-magnesium ekudleni kungakhuphula okuqukethwe kwamaminerali amathambo, ngaleyo ndlela kunciphise ingozi yokuphuka kanye ne-osteoporosis ngesikhathi sokuguga. I-Magnesium inendima embaxambili ekulungiseni amathambo. Phakathi nesigaba esinzima sokuvuvukala, i-magnesium ingakhuthaza inkulumo ye-TRPM7 kuma-macrophages, ukukhiqizwa kwe-cytokine encike ku-magnesium, futhi ikhuthaze i-immune microenvironment yokwakheka kwamathambo. Phakathi nesigaba sokuvuselela sekwephuzile sokuphulukiswa kwamathambo, i-magnesium ingathinta i-osteogenesis futhi ivimbele imvula ye-hydroxyapatite. I-TRPM7 kanye ne-magnesium nayo ibamba iqhaza ohlelweni lokubala kwe-vascular ngokuthonya ukuguqulwa kwamangqamuzana e-vascular smooth muscle kuya ku-osteogenic phenotype.

Izinga elijwayelekile le-magnesium ku-serum kubantu abadala lingu-1.7~2.4 mg/dl (0.7~1.0 mmol/L). I-Hypomagnesemia ibhekisela ekugxilweni kwe-magnesium ku-serum engaphansi kuka-1.7 mg/dl. Iningi leziguli ezine-borderline hypomagnesemia azinazo izimpawu ezisobala. Ngenxa yokuntula isikhathi eside kwe-magnesium engaba khona ezigulini ezinamazinga e-magnesium e-serum angaphezu kuka-1.5 mg/dl (0.6 mmol/L), abanye basikisela ukuphakamisa umkhawulo ophansi we-hypomagnesemia. Nokho, leli zinga lisenempikiswano futhi lidinga ukuqinisekiswa okwengeziwe komtholampilo. I-3% ~ 10% yabantu jikelele ine-hypomagnesemia, kanti izinga lezehlakalo zeziguli ezinesifo sikashukela sohlobo 2 (10% ~ 30%) kanye neziguli ezilaliswe esibhedlela (10% ~ 60%) liphezulu, ikakhulukazi ezigulini zasegunjini labagula kakhulu (ICU), izinga labo lokugula lingaphezu kwama-65%. Ucwaningo oluningi lweqembu luye lwabonisa ukuthi i-hypomagnesemia ihlotshaniswa nengozi eyandayo yokufa kwezimbangela kanye nokufa okuhlobene nesifo senhliziyo.

Ukubonakaliswa komtholampilo kwe-hypomagnesemia kuhlanganisa izimpawu ezingaqondile ezifana nokozela, ukugoqa kwemisipha, noma ubuthakathaka bemisipha obubangelwa ukudla okwanele kokudla, ukwanda kokulahlekelwa emathunjini, ukunciphisa ukubuyiswa kabusha kwezinso, noma ukusabalalisa kabusha kwe-magnesium kusuka ngaphandle kuya ngaphakathi kwamaseli (Umfanekiso 3B). I-Hypomagnesemia ivamise ukuhlangana nezinye izifo ze-electrolyte, okuhlanganisa i-hypocalcemia, i-hypokalemia, kanye ne-alkalosis ye-metabolic. Ngakho-ke, i-hypomagnesemia ingase inganakwa, ikakhulukazi kuzilungiselelo eziningi zomtholampilo lapho amazinga e-magnesium egazi engalinganiswanga njalo. Kuphela ku-hypomagnesemia enzima (i-serum magnesium<1.2 mg/dL [0.5 mmol/L]), izimpawu ezinjengokujabula okungavamile kwe-neuromuscular (i-wrist ankle spasms, isithuthwane, nokuzamazama), ukungahambi kahle kwenhliziyo nemithambo yegazi (i-arrhythmias ne-vasoconstriction), kanye nokuphazamiseka kwe-metabolic (ukungazweli kwe-insulin noqwanga). I-Hypomagnesemia ihlotshaniswa nokwanda kokulaliswa esibhedlela kanye namazinga okufa, ikakhulukazi uma kuhambisana ne-hypokalemia, okugqamisa ukubaluleka komtholampilo kwe-magnesium.
Okuqukethwe kwe-magnesium egazini kubala ngaphansi kuka-1%, ngakho-ke okuqukethwe kwe-magnesium egazini akukwazi ukubonisa ngokuthembekile inani eliphelele le-magnesium esicutshini. Ucwaningo luye lwabonisa ukuthi noma ngabe ukugxilwa kwe-magnesium ku-serum kuyinto evamile, okuqukethwe kwe-intracellular magnesium kungase kuqedwe. Ngakho-ke, ukucabangela kuphela okuqukethwe kwe-magnesium egazini ngaphandle kokucabangela ukudla okudlayo kwe-magnesium nokulahlekelwa umchamo kungase kubukele phansi ukuntuleka kwe-magnesium emtholampilo.

Iziguli ezine-hypomagnesemia zivame ukuba ne-hypokalemia. I-hypokalemia enenkani ivamise ukuhlotshaniswa nokuntuleka kwe-magnesium, futhi ingalungiswa ngempumelelo kuphela ngemva kokuba amazinga e-magnesium ebuyele kokujwayelekile. Ukushoda kwe-Magnesium kungakhuphula ukukhishwa kwe-potassium emathanjeni aqoqwayo, kuqhubekisele phambili ukulahleka kwe-potassium. Ukwehla kwamazinga e-magnesium e-intracellular kuvimbela umsebenzi we-Na+- K+- ATPase futhi kwandisa ukuvulwa kweziteshi ze-extrarenal medullary potassium (ROMK), okuholela ekulahlekelweni kwe-potassium eyengeziwe ezinso. Ukusebenzisana phakathi kwe-magnesium ne-potassium kuhlanganisa nokuvula i-sodium chloride co transporter (NCC), ngaleyo ndlela kukhuthaze ukumuncwa kabusha kwe-sodium. Ukushoda kwe-Magnesium kunciphisa ukuchichima kwe-NCC nge-E3 ubiquitin protein ligase ebizwa ngokuthi i-NEDD4-2, eyehlisa ukuthuthukiswa kweseli ye-neuronal precursor, futhi ivimbele ukusebenza kwe-NCC nge-hypokalemia. Ukwehliswa okuqhubekayo kwe-NCC kungathuthukisa ezokuthutha ze-distal Na+ ku-hypomagnesemia, okuholela ekwandeni kokuphuma kwe-potassium yomchamo kanye ne-hypokalemia.

I-Hypocalcemia nayo ijwayelekile ezigulini ezine-hypomagnesemia. Ukuntuleka kwe-Magnesium kungavimbela ukukhululwa kwehomoni ye-parathyroid (PTH) futhi kunciphise ukuzwela kwezinso ku-PTH. Ukwehla kwamazinga e-PTH kunganciphisa ukumuncwa kabusha kwe-calcium ezinso, kukhuphule ukuphuma kwe-calcium yomchamo, futhi ekugcineni kuholele ku-hypocalcemia. Ngenxa ye-hypocalcemia ebangelwa i-hypomagnesemia, i-hypoparathyroidism ivame ukuba nzima ukuyilungisa ngaphandle uma amazinga e-magnesium egazini ebuyela kokujwayelekile.

Isilinganiso se-magnesium seserum siyindlela ejwayelekile yokunquma okuqukethwe kwe-magnesium ekusebenzeni komtholampilo. Ingakwazi ukuhlola ngokushesha izinguquko zesikhathi esifushane kokuqukethwe kwe-magnesium, kodwa ingase ibukele phansi inani eliphelele le-magnesium emzimbeni. Izici ze-Endogenous (ezifana ne-hypoalbuminemia) nezici zangaphandle (njenge-specimen hemolysis nama-anticoagulant, njenge-EDTA) zingathinta inani lokulinganisa le-magnesium, futhi lezi zici zidinga ukucatshangelwa lapho kuchazwa imiphumela yokuhlolwa kwegazi. I-Serum ionized magnesium nayo ingalinganiswa, kodwa ukusebenza kwayo emtholampilo akukacaci.
Lapho kuhlolwa i-hypomagnesemia, imbangela ngokuvamile inganqunywa ngokusekelwe kumlando wezokwelapha wesiguli. Kodwa-ke, uma ingekho imbangela ecacile eyisisekelo, izindlela ezithile zokuxilonga zidinga ukusetshenziswa ukuze kuhlukaniswe ukuthi ukulahlekelwa kwe-magnesium kubangelwa izinso noma umgudu wamathumbu, njengokuphuma kwe-magnesium yamahora angu-24, ingxenye ye-magnesium excretion, nokuhlolwa komthwalo we-magnesium.

Izithako ze-Magnesium ziyisisekelo sokwelapha i-hypomagnesemia. Kodwa-ke, okwamanje asikho isiqondiso sokwelashwa esicacile se-hypomagnesemia; Ngakho-ke, indlela yokwelapha ngokuyinhloko incike ebukhulu bezimpawu zomtholampilo. I-hypomagnesemia emnene ingelashwa ngezithako zomlomo. Kunamalungiselelo amaningi e-magnesium emakethe, ngalinye linamazinga ahlukene okumuncwa. Usawoti we-organic (njenge-magnesium citrate, i-magnesium aspartate, i-magnesium glycine, i-magnesium gluconate, ne-magnesium lactate) amuncwa kalula emzimbeni womuntu kunosawoti we-inorganic (njenge-magnesium chloride, i-magnesium carbonate, ne-magnesium oxide). Umphumela ovamile ohlangothini lwezithako ze-magnesium oral uhudo, olubeka inselele ekufakweni kwe-magnesium ngomlomo.
Ezimweni eziphikisayo, ukwelashwa kwezidakamizwa ze-adjuvant kungase kudingeke. Ezigulini ezinomsebenzi wezinso ojwayelekile, ukuvimbela iziteshi ze-epithelial sodium nge-aminophenidate noma i-triaminophenidate kungakhuphula amazinga e-serum magnesium. Amanye amasu angenzeka ahlanganisa ukusetshenziswa kwe-SGLT2 inhibitors ukukhulisa amazinga e-serum magnesium, ikakhulukazi ezigulini ezinesifo sikashukela. Izindlela ezingemuva kwale miphumela azikacaci kahle, kodwa zingase zihlotshaniswe nokuncipha kwezinga lokuhlunga kwe-glomerular kanye nokwenyuka kokubuyiswa kabusha kwe-renal tubular. Ezigulini ezine-hypomagnesemia ezingasebenzi kahle ekwelashweni kwe-magnesium oral, njengalezo ezine-bowel syndrome emfushane, ukuquleka kwezandla nezinyawo, noma isithuthwane, kanye nalabo abanokungaqini kwe-hemodynamic okubangelwa i-arrhythmia, i-hypokalemia, ne-hypocalcemia, ukwelapha nge-intravenous kufanele kusetshenziswe. I-hypomagnesemia ebangelwa i-PPI ingathuthukiswa ngokuphathwa ngomlomo kwe-inulin, futhi indlela yayo ingase ihlobane nezinguquko ku-gut microbiota.

I-Magnesium iyi-electrolyte ebalulekile kodwa evame ukunganakwa ekuxilongeni nasekwelashweni komtholampilo. Akuvamile ukuthi ihlolwe njenge-electrolyte evamile. I-Hypomagnesemia ngokuvamile ayinazo izimpawu. Nakuba indlela eqondile yokulawula ibhalansi ye-magnesium emzimbeni ingakacaci, inqubekela phambili yenziwe ocwaningweni lomshini izinso ezicubungula ngayo i-magnesium. Izidakamizwa eziningi zingabangela i-hypomagnesemia. I-Hypomagnesemia ijwayelekile phakathi kweziguli ezilaliswe esibhedlela futhi iyisici esiyingozi sokuhlala isikhathi eside kwe-ICU. I-Hypomagnesemia kufanele ilungiswe ngendlela yamalungiselelo kasawoti we-organic. Nakuba kusenezimfihlakalo eziningi okufanele zixazululwe mayelana nendima ye-magnesium empilweni nasezifo, kube nentuthuko eminingi kulo mkhakha, futhi odokotela basemtholampilo kufanele banake kakhulu ukubaluleka kwe-magnesium emithini yomtholampilo.