239例药源性低镁血症文献分析

Literature Analysis on 239 Cases of Drug-Induced Hypomagnesemia

目的:探讨引起低镁血症的药品种类及其临床特征,提醒临床用药时警惕低镁血症的发生。方法:检索自建库至2021年3月中国知网、万方数据库和PubMed等数据库中药物引起低镁血症的相关文献,汇总病例分析中易引起低镁血症的药品种类、临床特征、治疗转归及相关影响因素。结果:共纳入药源性低镁血症个案报道文献20篇,多案例报道文献3篇,合计239例患者,涉及不同药理作用的5大类11种药品,包括免疫抑制剂(119例,占49.79%)、抗肿瘤药(102例,占42.68%)、质子泵抑制剂(15例,占6.28%)、抗菌药物(2例,占0.84%)和H;受体拮抗剂(1例,占0.42%)。个案报道的24例患者中,低镁血症程度分级为4级的有13例,3级3例,2级5例,1级3例。低镁血症的临床表现以神经-肌肉症状、意识改变伴癫痫和心血管症状为主。结论:患者服用上述易引起低镁血症的药物时,尤其是合并多种慢性疾病、长期联合应用多种药物治疗的中老年患者,临床应警惕药源性低镁血症,定期监测血镁浓度和神经系统症状,预防低镁血症的发生,根据患者血镁浓度水平和临床症状针对性治疗。

OBJECTIVE: To investigate the types and clinical characteristics of drug-induced hypomagnesemia, so as to remind the clinic to be alert to the occurrence of hypomagnesemia. METHODS: CNKI, Wanfang Data and PubMed were retrieved to collect the related literature of drug-induced hypomagnesemia, the retrieval time was from the establishment of the database to Mar. 2021. Types of drugs, clinical characteristics, treatment outcomes and related influencing factors that were likely to induce hypomagnesemia were summarized and analyzed. RESULTS: A total of 239 patients were enrolled in 20 case reports and 3 multi-case reports, there were 11 kinds of drugs in 5 categories with different pharmacological effects, including immunosuppressants(119 cases, 49.79%), antitumor drugs(102 cases, 42.68%), proton pump inhibitors(15 cases, 6.28%), antibiotics(2 cases, 0.84%) and H;receptor antagonists(1 case, 0.42%). Among the 24 cases reported, the degree of hypomagnesemia was graded as grade 4 in 13 cases, grade 3 in 3 cases, grade 2 in 5 cases and grade 1 in 3 cases. The clinical manifestations of hypomagnesemia were mainly neuromuscular symptoms, altered consciousness with epilepsy and cardiovascular symptoms. CONCLUSIONS: Patients taking the above drugs that are likely to induce hypomagnesemia, especially the combination of multiple chronic diseases, long-term combined application of multiple drug therapy in middle-aged and elderly patients, clinicians should be alert to drug-induced hypomagnesemia, regularly provide monitoring for blood magnesium concentration and neurological symptoms to prevent the occurrence of hypomagnesemia. The treatment is targeted according to patients’ blood magnesium concentration level and clinical symptoms.