Tsujii Toshiyasu, Ogaki Takafumi, Nakae Kaori, Imai Kiyotaka, Kise Daisuke, Tada Shoji, Ueda Hiroki, Moriyama Masahiro
Section of Clinical Pharmaceutics, Department of Clinical Pharmacy, Graduate School of Pharmacy, Hyogo University of Health Sciences, 1-3-6, Minatojima, Chuo-ku, Kobe, Hyogo 665-8530 Japan ; Department of Pharmacy, Toyooka Public Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan.
Department of Pharmacy, Toyooka Public Hospital, 1094, Tobera, Toyooka, Hyogo 668-8501 Japan.
J Pharm Health Care Sci. 2016 Sep 22;2:23. doi: 10.1186/s40780-016-0060-9. eCollection 2016.
Hypomagnesemia is one of the characteristic side effects of the human anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, cetuximab and panitumumab. The major mechanism of anti-EGFR antibody-related hypomagnesemia is suppression of EGFR-mediated urinary Mg(2+) reabsorption in both the renal tubule the intestinal tract. Since Mg(2+) is known to affect blood Ca(2+) levels through regulation of parathyroid hormone (PTH) secretion, we investigated the correlation between Ca(2+) and Mg(2+) concentration in blood.
Between April 2012 and October 2015, blood Mg(2+) and Ca(2+) concentrations (albumin corrected value) of 22 colon cancer patients undergoing treatment with either cetuximab or panitumumab at Toyooka Public Hospital were measured simultaneously.
Hypomagnesemia (of all Grades) was reported in 13 of 22 patients. Two patients had hypomagnesemia of severity > Grade 3. Changes in blood Mg(2+) and Ca(2+) concentration showed a significant correlation (r(2) = 0.7455), which could be expressed using the following equation, Ca(2+) concentration = 1.4268 × (Mg(2+) concentration) + 7.1126.
Since the early stages of hypomagnesemia produce no characteristic clinical symptoms, it is easily overlooked until it becomes severe. The investigation results suggest that if low blood Ca(2+) concentration (mg/dL) is observed in patients administered anti-EGFR antibodies, early evaluation of blood Mg(2+) concentration (mg/dL) and prompt supportive care are required to prevent aggravation of hypomagnesemia.
低镁血症是西妥昔单抗和帕尼单抗这两种人抗表皮生长因子受体（EGFR）单克隆抗体的特征性副作用之一。抗EGFR抗体相关低镁血症的主要机制是抑制肾小管和肠道中EGFR介导的尿镁（Mg²⁺）重吸收。由于已知Mg²⁺通过调节甲状旁腺激素（PTH）分泌来影响血钙（Ca²⁺）水平，我们研究了血液中Ca²⁺与Mg²⁺浓度之间的相关性。
2012年4月至2015年10月期间，对丰冈公立医院22例接受西妥昔单抗或帕尼单抗治疗的结肠癌患者同时测定血镁（Mg²⁺）和血钙（Ca²⁺）浓度（白蛋白校正值）。
22例患者中有13例报告有低镁血症（所有级别）。2例患者的低镁血症严重程度>3级。血镁（Mg²⁺）和血钙（Ca²⁺）浓度变化呈显著相关性（r² = 0.7455），可用以下方程表示：血钙（Ca²⁺）浓度 = 1.4268×（血镁（Mg²⁺）浓度） + 7.1126。
由于低镁血症早期无特征性临床症状，很容易被忽视，直至病情严重。研究结果表明，如果在接受抗EGFR抗体治疗的患者中观察到血钙（Ca²⁺）浓度低（mg/dL），需要早期评估血镁（Mg²⁺）浓度（mg/dL）并及时给予支持性治疗，以防止低镁血症加重。
