Saito Yoshitaka, Kobayashi Masaki, Yamada Takehiro, Kasashi Kumiko, Honma Rio, Takeuchi Satoshi, Shimizu Yasushi, Kinoshita Ichiro, Dosaka-Akita Hirotoshi, Iseki Ken
Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
Laboratory of Clinical Pharmaceutics and Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
Support Care Cancer. 2017 Feb;25(2):481-487. doi: 10.1007/s00520-016-3426-5. Epub 2016 Oct 3.
Magnesium supplementation is an effective protective method against cisplatin-induced nephrotoxicity (CIN); however, there are few reports regarding the mechanism of its nephroprotective effect. The aim of this study was to determine whether premedication with intravenous magnesium prevents CIN and to determine the relationship between its nephroprotective effect and serum magnesium level.
Fifty-eight patients with head and neck cancer who received cisplatin, docetaxel, and 5-fluorouracil (DCF) were retrospectively investigated. Grade 2 or more serum creatinine elevation was defined as CIN. The incidence of CIN was compared between a magnesium sulfate (20 mEq, 2.46 g) premedication group and a non-magnesium group during the first cycle and in all cycles.
CIN did not occur in any patients receiving magnesium premedication but did occur in 5 of 29 patients during the first cycle and in 6 patients during all subsequent cycles in patients who did not receive magnesium premedication. Furthermore, the variation of creatinine clearance was significantly worse in the non-magnesium group than in the magnesium premedication group from baseline. There was no difference in adverse effects or response rate between the two groups. Univariate analysis suggested that magnesium premedication significantly reduced the risk of CIN. On the other hand, serum magnesium depletion was seen in both groups to equal degrees despite supplementation.
Intravenous magnesium premedication has a protective effect on cisplatin-induced nephrotoxicity without the influence on the serum magnesium level. Magnesium premedication is a simple nephroprotective method that does not influence other adverse effects or rate of response to chemotherapy.
补充镁是一种有效预防顺铂诱导的肾毒性（CIN）的保护方法；然而，关于其肾保护作用机制的报道较少。本研究的目的是确定静脉注射镁预处理是否能预防CIN，并确定其肾保护作用与血清镁水平之间的关系。
回顾性研究了58例接受顺铂、多西他赛和5-氟尿嘧啶（DCF）治疗的头颈癌患者。血清肌酐升高2级或更高被定义为CIN。比较硫酸镁（20 mEq，2.46 g）预处理组和非镁组在第一个周期及所有周期中CIN的发生率。
接受镁预处理的患者中无一例发生CIN，但未接受镁预处理的患者在第一个周期中有5例发生CIN，在所有后续周期中有6例发生CIN。此外，从基线开始，非镁组肌酐清除率的变化明显比镁预处理组更差。两组在不良反应或缓解率方面没有差异。单因素分析表明，镁预处理显著降低了CIN的风险。另一方面，尽管进行了补充，但两组血清镁缺乏程度相当。
静脉注射镁预处理对顺铂诱导的肾毒性有保护作用，且不影响血清镁水平。镁预处理是一种简单的肾保护方法，不影响其他不良反应或化疗缓解率。
