amakuru

Sodium, potasiyumu, calcium, bicarbonate, hamwe nuburinganire bwamazi mumaraso nibyo shingiro ryo gukomeza imirimo yumubiri. Habayeho kubura ubushakashatsi ku ndwara ya magnesium. Nko mu myaka ya za 1980, magnesium yari izwi nka "electrolyte yibagiwe". Hamwe no kuvumbura imiyoboro yihariye ya magnesium nabatwara abantu, hamwe no gusobanukirwa nogutunganya physiologique na hormone ya magnesium homeostasis, abantu bumva uruhare rwa magnesium mubuvuzi bwamavuriro bahora biyongera.

Magnesium ningirakamaro mumikorere ya selile nubuzima. Ubusanzwe Magnesium ibaho muburyo bwa Mg2 +, kandi iboneka mu ngirabuzimafatizo zose z’ibinyabuzima byose, kuva ku bimera kugeza ku nyamaswa z’inyamabere. Magnesium ni ikintu cy'ingenzi mu buzima no ku buzima, kuko ari cofactor y'ingirakamaro y'ingirabuzimafatizo ya ATP. Magnesium igira uruhare runini mubikorwa byingenzi byimikorere ya selile ihuza nucleotide no kugenzura ibikorwa bya enzyme. Ibisubizo byose bya ATPase bisaba Mg2 + - ATP, harimo reaction zijyanye n'imikorere ya RNA na ADN. Magnesium ni cofactor ya magana yimikorere ya selile. Byongeye kandi, magnesium igenga kandi glucose, lipide, na protein metabolism. Magnesium igira uruhare mu kugenzura imikorere ya neuromuscular, kugenzura injyana yumutima, ijwi ryimitsi, imisemburo ya hormone, no kurekura N-methyl-D-aspartate (NMDA) muri sisitemu yo hagati. Magnesium ni intumwa ya kabiri igira uruhare mu gutangaza ibimenyetso no kugenzura ingirabuzimafatizo ya genoside igenzura injyana ya sisitemu y'ibinyabuzima.

Hafi ya g 25 za magnesium mumubiri wumuntu, zibikwa cyane mumagufa nuduce tworoshye. Manyeziyumu ni ion y'ingirakamaro kandi ni iya kabiri mu ntera nini nyuma ya potasiyumu. Mu ngirabuzimafatizo, 90% kugeza 95% bya magnesium bihuza ligande nka ATP, ADP, citrate, proteyine, na acide nucleic, mugihe 1% kugeza 5% bya magnesium yo mu nda ibaho muburyo bwubuntu. Imyunyungugu ya magnesium yubusa ni 1,2-2.9 mg / dl (0.5-1.2 mmol / L), bisa nubushuhe budasanzwe. Muri plasma, 30% ya magnesium izenguruka ihuza poroteyine ahanini binyuze muri aside irike yubusa. Abarwayi bafite aside irike ndende ya acide yubusa mubisanzwe bafite amaraso ya magnesium yo mu maraso make, ibyo bikaba bihwanye cyane n’ibyago byo kwandura indwara z'umutima n'imitsi. Imihindagurikire ya acide yubusa, kimwe nurwego rwa EGF, insuline, na aldosterone, birashobora kugira ingaruka kumaraso ya magnesium.

Hariho ingingo eshatu zingenzi zigenga magnesium: amara (agenga iyinjizwa ryimirire ya magnesium), amagufwa (kubika magnesium muburyo bwa hydroxyapatite), nimpyiko (igenga gusohora inkari za magnesium). Izi sisitemu zahujwe kandi zihujwe cyane, hamwe zikora igifu cyo mu nda impyiko, ishinzwe kwinjiza, guhana, no gusohora magnesium. Ubusumbane bwa magnesium metabolism bushobora kuganisha ku ngaruka za patologi na physiologique

Ibiribwa bikungahaye kuri magnesium birimo ibinyampeke, ibishyimbo, imbuto, n'imboga rwatsi (magnesium ni cyo kintu cy'ibanze cya chlorophyll). Hafi ya 30% kugeza 40% yo gufata ibiryo bya magnesium byinjira mu mara. Kwinjira kwinshi biboneka mu mara mato binyuze mu bwikorezi bwimikorere, inzira ya pasiporo irimo ihuriro rikomeye hagati ya selile. Amara manini arashobora kugenga neza iyinjizwa rya magnesium binyuze muri TRPM6 na TRPM7. Kudakora gene yo munda TRPM7 birashobora gutuma habaho kubura cyane muri magnesium, zinc, na calcium, bikaba byangiza imikurire hakiri kare no kubaho nyuma yo kuvuka. Kwinjira kwa Magnesium biterwa nibintu bitandukanye, birimo gufata magnesium, agaciro ka pH yo munda, imisemburo (nka estrogene, insuline, EGF, FGF23, na hormone parathiyide [PTH]), na microbiota yo munda.
Mu mpyiko, impyiko zifata reabsorb magnesium zinyuze mu nzira zidasanzwe ndetse no mu nda. Bitandukanye na ion nyinshi nka sodium na calcium, umubare muto (20%) wa magnesium usubizwa muri tubules yegeranye, mugihe ubwinshi (70%) bwa magnesium bwongeye gusubizwa mumuzinga wa Heinz. Muri tubules yegeranye n'amashami mato ya Heinz loop, magnesium reabsorption iterwa ahanini na gradients hamwe nibishobora kubaho. Claudin 16 na Claudin 19 bagize imiyoboro ya magnesium mumashami yimbitse ya Heinz loop, mugihe Claudin 10b ifasha gukora voltage nziza yo mu nda hejuru ya selile epithelia, bigatuma magnesium ion reabsorption. Muri tubules ya kure, magnesium igenga neza reabsorption yo mu nda (5% ~ 10%) ikoresheje TRPM6 na TRPM7 kumutwe wa selile, bityo ikagena gusohora inkari za magnesium zanyuma.
Manyeziyumu ni ikintu cy'ingenzi kigize amagufwa, kandi 60% ya magnesium mu mubiri w'umuntu ibikwa mu magufa. Magnesium ihinduranya mumagufa itanga ububiko bukomeye bwo gukomeza plasma physiologique. Magnesium itera amagufwa muguhindura ibikorwa bya osteoblasts na osteoclasts. Kwiyongera kwa magnesium birashobora kongera imyunyu ngugu, bityo bikagabanya ibyago byo kuvunika na osteoporose mugihe cyo gusaza. Magnesium ifite uruhare runini mugusana amagufwa. Mugihe cyicyiciro gikomeye cyo gutwika, magnesium irashobora guteza imbere imvugo ya TRPM7 muri macrophage, umusaruro wa magnesium ukomoka kuri cytokine, kandi ugateza imbere ibidukikije bikingira umubiri. Mugihe cyanyuma cyo kuvugurura amagufwa, magnesium irashobora kugira ingaruka kuri osteogenez kandi ikabuza imvura ya hydroxyapatite. TRPM7 na magnesium nazo zigira uruhare mugikorwa cyo kubara kwamaraso bigira ingaruka kumihindagurikire yimitsi yimitsi iva mumitsi kuri osteogeneque phenotype.

Ubusanzwe serumu magnesium yibanze mubantu bakuru ni 1,7 ~ 2,4 mg / dl (0.7 ~ 1.0 mmol / L). Hypomagnesemia bivuga serum magnesium yibanze munsi ya 1,7 mg / dl. Abenshi mu barwayi bafite hypomagnesemia imipaka nta bimenyetso bigaragara. Bitewe nuko bishoboka ko magnesium ishobora kubura igihe kirekire kubarwayi bafite serumu ya magnesium irenga 1.5 mg / dl (0,6 mmol / L), bamwe bavuga ko bazamura urwego rwo hasi rwa hypomagnesemia. Nyamara, uru rwego ruracyavuguruzanya kandi rusaba kwemezwa kwa muganga. 3% ~ 10% by'abaturage muri rusange bafite hypomagnesemia, mu gihe umubare w'abarwayi ba diyabete yo mu bwoko bwa 2 (10% ~ 30%) n'abarwayi bari mu bitaro (10% ~ 60%) uri hejuru, cyane cyane mu barwayi bashinzwe ubuvuzi bukomeye (ICU), umubare wabo w'abanduye ukaba urenga 65%. Ubushakashatsi bwinshi bwakozwe na cohort bwerekanye ko hypomagnesemia ifitanye isano no kwiyongera kwimpfu zose ziterwa nimpfu ziterwa nindwara z'umutima.

Kugaragara kwa clinique ya hypomagnesemia harimo ibimenyetso bidasanzwe nko gusinzira, kunanuka kw'imitsi, cyangwa intege nke z'imitsi biterwa no gufata indyo idahagije, gutakaza igifu, kugabanuka kw'impyiko, cyangwa gukwirakwiza magnesium kuva hanze kugeza imbere mu ngirabuzimafatizo (Ishusho 3B). Hypomagnesemia isanzwe ibana nizindi ndwara za electrolyte, harimo hypocalcemia, hypokalemia, na alkalose ya metabolike. Kubwibyo, hypomagnesemia irashobora kwirengagizwa, cyane cyane mumavuriro menshi aho urugero rwa magnesium yamaraso idapimwa bisanzwe. Gusa muri hypomagnesemia ikabije (serumu magnesium <1,2 mg / dL [0.5 mmol / L]), ibimenyetso nko kwishima bidasanzwe bya neuromuscular (spasms y'intoki, epilepsy, hamwe no guhinda umushyitsi), indwara z'umutima n'imitsi idasanzwe (arththmias na vasoconstriction), hamwe no guhindagurika kwa insuline). Hypomagnesemia ifitanye isano no kwiyongera mu bitaro ndetse n’impfu, cyane cyane iyo iherekejwe na hypokalemia, ikagaragaza akamaro k’amavuriro ya magnesium.
Ibinyamavuta bya magnesium biri mu maraso bingana na 1%, bityo rero amaraso ya magnesium ntashobora kwerekana neza ibyuzuye byose bya magnesium mubice. Ubushakashatsi bwerekanye ko niyo serum ya magnesium yibisanzwe ari ibisanzwe, ibinyabuzima bya magnesium bishobora kuba byagabanutse. Kubwibyo, urebye gusa magnesium iri mumaraso utitaye kubyo kurya bya magnesium byokurya no gutakaza inkari bishobora gupfobya ibura rya magnesium.

Abarwayi bafite hypomagnesemia bakunze guhura na hypokalemia. Kwinangira hypokalemia mubisanzwe bifitanye isano no kubura magnesium, kandi birashobora gukosorwa neza nyuma ya magnesium igarutse mubisanzwe. Ibura rya magnesium rirashobora gutuma potasiyumu isohoka mu miyoboro ikusanya, bikarushaho kwiyongera gutakaza potasiyumu. Kugabanuka kurwego rwa magnesium internacellularulaire bibuza ibikorwa bya Na + - K + - ATPase kandi byongera gufungura imiyoboro ya potassium ya medullary idasanzwe (ROMK), bigatuma potasiyumu itakaza impyiko nyinshi. Imikoranire hagati ya magnesium na potasiyumu ikubiyemo no gukora sodium chloride co gutwara (NCC), bityo igatera sodium reabsorption. Kubura Magnesium bigabanya ubwinshi bwa NCC binyuze muri E3 ubiquitin protein ligase yitwa NEDD4-2, igabanya imikurire ya neuronal precursor selile, kandi ikabuza gukora NCC binyuze muri hypokalemia. Gukomeza kugabanuka kwa NCC birashobora kongera ubwikorezi bwa kure Na + muri hypomagnesemia, biganisha ku gusohora potasiyumu yinkari hamwe na hypokalemia.

Hypocalcemia ikunze kugaragara no ku barwayi barwaye hypomagnesemia. Kubura Magnesium birashobora kubuza gusohora imisemburo ya parathiyide (PTH) kandi bikagabanya ubukana bwimpyiko kuri PTH. Kugabanuka kurwego rwa PTH birashobora kugabanya calcium yimpyiko reabsorption, kongera calcium yinkari zisohoka, kandi amaherezo biganisha kuri hypocalcemia. Bitewe na hypocalcemia iterwa na hypomagnesemia, hypoparathyroidism akenshi biragoye kuyikosora keretse urugero rwa magnesium yamaraso asubiye mubisanzwe.

Ibipimo bya magnesium byuzuye ni uburyo busanzwe bwo kumenya ibirimo magnesium mubikorwa byubuvuzi. Irashobora gusuzuma byihuse impinduka zigihe gito mubirimo magnesium, ariko irashobora gupfobya ibirimo byose bya magnesium mumubiri. Impamvu za endogenous (nka hypoalbuminemia) hamwe nibintu bidasanzwe (nka hemolysis na anticoagulants, nka EDTA) bishobora kugira ingaruka ku gipimo cyo gupima magnesium, kandi ibyo bintu bigomba kwitabwaho mugihe cyo gusobanura ibyavuye mu gupima amaraso. Serumu ionisiyumu ya magnesium nayo irashobora gupimwa, ariko ibikorwa byayo byubuvuzi ntibirasobanuka neza.
Iyo usuzumye hypomagnesemia, igitera gishobora kumenyekana ukurikije amateka yubuvuzi bwumurwayi. Ariko, niba nta mpamvu ifatika igaragara, hagomba gukoreshwa uburyo bwihariye bwo gusuzuma kugirango hamenyekane niba gutakaza magnesium biterwa nimpyiko cyangwa gastrointestinal, nko gusohora amasaha 24 ya magnesium, igice cyo gusohora magnesium, hamwe no gupima umutwaro wa magnesium.

Inyongera ya Magnesium niyo shingiro ryo kuvura hypomagnesemia. Ariko, kuri ubu nta murongo ngenderwaho usobanutse wo kuvura hypomagnesemia; Kubwibyo, uburyo bwo kuvura buterwa ahanini nuburemere bwibimenyetso byamavuriro. Hypomagnesemia yoroheje irashobora kuvurwa hamwe ninyongera. Hariho imyiteguro myinshi ya magnesium ku isoko, buri kimwe gifite igipimo cyo kwinjiza. Umunyu kama (nka magnesium citrate, magnesium aspartate, magnesium glycine, magnesium gluconate, na magnesium lactate) byinjizwa byoroshye numubiri wumuntu kuruta imyunyu ngugu (nka magnesium chloride, karubone ya magnesium, na oxyde ya magnesium). Ingaruka rusange yinyongera ya magnesium yo mu kanwa ni impiswi, itera ikibazo cyo kongerera magnesium umunwa.
Kubibazo byangiritse, kuvura imiti irashobora gukenerwa. Ku barwayi bafite imikorere isanzwe yimpyiko, kubuza epiteliyale sodium ya sodium hamwe na aminophenidate cyangwa triaminophenidate irashobora kongera urugero rwa serumu magnesium. Izindi ngamba zishoboka zirimo gukoresha SGLT2 inhibitor kugirango yongere urugero rwa serumu magnesium, cyane cyane kubarwayi ba diyabete. Uburyo bwihishe inyuma yizi ngaruka ntiburasobanuka neza, ariko birashobora kuba bifitanye isano no kugabanuka kwikigereranyo cyo kuyungurura isi no kwiyongera kwimpyiko reabsorption. Ku barwayi barwaye hypomagnesemia badafite akamaro mu kuvura inyongera ya magnesium yo mu kanwa, nk'abafite syndrome yo mu mara magufi, gufatwa n'amaguru n'amaguru, cyangwa igicuri, kimwe n'abafite ihungabana rya hemodinamike riterwa na rubagimpande, hypokalemia, na hypocalcemia, hakwiye gukoreshwa imiti ivura imitsi. Hypomagnesemia iterwa na PPI irashobora kunozwa nubuyobozi bwo mu kanwa bwa inuline, kandi uburyo bwabwo bushobora kuba bujyanye nimpinduka za microbiota.

Magnesium ningirakamaro ariko akenshi yirengagizwa na electrolyte mugupima no kuvura. Ntibisanzwe bipimwa nka electrolyte isanzwe. Hypomagnesemia mubusanzwe nta bimenyetso ifite. Nubwo uburyo nyabwo bwo kugenzura uburinganire bwa magnesium mu mubiri butarasobanuka neza, intambwe imaze guterwa mu kwiga uburyo impyiko zitunganya magnesium. Imiti myinshi irashobora gutera hypomagnesemia. Hypomagnesemia ikunze kugaragara mu barwayi bari mu bitaro kandi ni ibintu bishobora gutera igihe kirekire ICU. Hypomagnesemia igomba gukosorwa muburyo bwo gutegura umunyu kama. Nubwo hakiri amayobera menshi agomba gukemurwa ku ruhare rwa magnesium mu buzima n’indwara, habaye iterambere ryinshi muri uru rwego, kandi abaganga b’amavuriro bakwiye kwita cyane ku kamaro ka magnesium mu buvuzi bw’amavuriro.