【摘要】目的分析维持性血液透析(maintenance hemodialysis，MHD)患者血镁现状，探讨血镁影响因素及其与心脑血管事件的关系。方法筛选2018 年3 月在南通大学附属医院血液透析中心常规接受MHD 治疗的126 名患者，收集患者基本资料、临床指标，随访24 个月，每6 个月评估并且记录患者一般性情况及临床指标。结果126 名患者中血镁正常组[(1.01±0.08)mmol/L]50 例,高镁血症组[(1.27±0.16)mmol/L]76 例，无低镁血症患者。多因素Logistic 回归分析显示，血清白蛋白较高(OR=2.020, 95% CI 1.497～2.727, P＜0.001)、超敏C 反应蛋白较低(OR=0.904，95% CI 0.824～0.992，P=0.034)的MHD 患者血镁水平更高。多因素COX 比例风险模型显示血镁水平低是心脑血管事件的独立危险因素(HR=7.461，95% CI 2.005～27.766，P=0.003)。结论MHD 患者中血镁较高者其营养状态好，炎症水平低，且心脑血管事件患病风险低于正常血镁患者。MHD 治疗患者维持轻度高镁水平可能获益更多。
【Abstract】Objective The study was to analyze the current situation of serum magnesium (Mg) in maintenance hemodialysis (MHD) patients, the influencing factors for serum Mg level, and the relationship between serum Mg and cardio-cerebrovascular events. Methods We analyzed 126 patients treated with MHD in March 2018 at the Blood Purification Center, the Affiliated Hospital of Nantong University. And they were followed up for 24 months. Results Multivariate logistic regression analysis showed that patients with higher serum albumin (OR=2.020, 95% CI: 1.497～2.727, P＜0.001) and lower high-sensitivity C-reactive protein
(OR=0.904, 95% CI: 0.824～0.992, P=0.034) had higher serum Mg level. Multivariate COX proportional hazard analysis showed that lower serum Mg was the independent risk factor for adverse cardio-cerebrovascular events (HR=7.461, 95% CI: 2.005～27.766, P=0.003). Conclusions MHD patients with hypermagnesemia had better nutritional status, lower inflammatory level, and lower risk of cardio-cerebrovascular events than patients with normal serum Mg. Therefore, maintenance of serum Mg at a slightly higher level may be beneficial for MHD patients.
[1] Navarro‐González Juan F, Mora‐Fernández Carmen. Reviews: Clinical Implications of Disordered Magnesium Homeostasis in Chronic Renal Failure and Dialysis; proceedings of the Seminars in Dialysis, F, 2009, 22: 37-44.
[2] Van Laecke S, Van Biesen W, Vanholder R. Hypomagnesaemia, the kidney and the vessels [J]. Nephrol Dial Transplant, 2012, 27(11): 4003-4010.
[3] Bressendorff I, Hansen D, Schou M, et al. The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease: A Randomized, Controlled Clinical Trial [J]. Clinical journal of the American Society of Nephrology : CJASN, 2018, 13(9): 1373-1380.
[4] Jo?o MP, Azevedo A, Laranjinha I, et al. Lower serum magnesium is associated with cardiovascular risk factors and mortality in haemodialysis patients [J]. Blood purification, 2014, 38: 244-252.
[5] Del Gobbo LC, Imamura F, Wu JH, et al. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies [J]. American Journal of Clinical Nutrition, 2013, 98(1): 160-173.
[6] Ma J, Folsom AR, Melnick SL, et al. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study [J]. Journal of Clinical Epidemiology, 1995, 48(7): 927-940.
[7] Reffelmann T, D?rr M, Ittermann T, et al. Low serum magnesium concentrations predict increase in left ventricular mass over 5 years independently of common cardiovascular risk factors [J]. Atherosclerosis, 2010, 213(2): 563-569.
[8] Reffelmann T, Ittermann T, D?rr M, et al. Low serum magnesium concentrations predict cardiovascular and all-cause mortality [J]. Atherosclerosis, 2011, 219(1): 280-284.
[9] Alhosaini M, Leehey DJ. Magnesium and Dialysis: The Neglected Cation [J]. American journal of kidney diseases : the official journal of the National Kidney Foundation, 2015, 66(3): 523-531.
[10] Masakane I, Taniguchi M, Nakai S, et al. Annual Dialysis Data Report 2015, JSDT Renal Data Registry [J]. Renal Replacement Therapy, 2018, 4(1): 19.
[11] Chirakarnjanakorn S, Navaneethan SD, Francis GS, et al. Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations [J]. International journal of cardiology, 2017, 232: 12-23.
[12] Lacson E, Wang W, Ma L, et al. Serum Magnesium and Mortality in Hemodialysis Patients in the United States: A Cohort Study [J]. American Journal of Kidney Diseases, 2015, 66(6): 1056-1066.
[13] Massy ZA, Drüeke TB. Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis and survival [J]. Clinical kidney journal, 2012, 5: i52-i61.
[14] Ter Braake AD, Shanahan CM, De Baaij JHF. Magnesium Counteracts Vascular Calcification: Passive Interference or Active Modulation? [J]. Arteriosclerosis Thrombosis & Vascular Biology, 2017, 37(8): 1431.
[15] Sakaguchi Y, Fujii N, Shoji T, et al. Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis [J]. Kidney international, 2014, 85(1): 174-181.
[16] Turgut F, Kanbay M, Metin MR, et al. Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis [J]. International urology and nephrology, 2008, 40(4): 1075-1082.
[17] Mortazavi M, Moeinzadeh F, Saadatnia M, et al. Effect of magnesium supplementation on carotid intima-media thickness and flow-mediated dilatation among hemodialysis patients: a double-blind, randomized, placebo-controlled trial [J]. European neurology, 2013, 69(5): 309-316.
[18] Fang L, Tang B, Hou D, et al. Effect of parathyroid hormone on serum magnesium levels: the neglected relationship in hemodialysis patients with secondary hyperparathyroidism [J]. Renal failure, 2016, 38(1): 50-56.
[19] Apetrii M, Covic A, Massy ZA. Magnesium supplementation: A consideration in dialysis patients [J]. Seminars in dialysis, 2018, 31(1): 11-14.
[20] Sonoo M, Yoshiko N, Kazuomi Y, et al. Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients [J]. International Urology and Nephrology, 2019, 1-10.
[21] Yu L, Li H, Wang SX. Serum Magnesium and Mortality in Maintenance Hemodialysis Patients [J]. Blood purification, 2017, 43: 31-36.
[22] Pakfetrat M, Malekmakan L, Roozbeh J, et al. Magnesium and its relationship to C-reactive protein among hemodialysis patients [J]. Magnesium research, 2008, 21(3): 167-170.
[23] Mazur A, Maier JA, Rock E, et al. Magnesium and the inflammatory response: Potential physiopathological implications [J]. Archives of Biochemistry & Biophysics, 2007, 458(1): 48-56.
