Duke-NUS Medical School, Singapore, Singapore,
Roxanna Todd Hodges Stroke Program, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
Cerebrovasc Dis. 2023;52(5):539-542. doi: 10.1159/000528385. Epub 2023 Jan 4.
Magnesium (Mg) is a neuroprotectant in preclinical models. Lower serum Mg levels have been associated with symptomatic hemorrhagic transformation (HT) in patients with ischemic stroke. Early treatment of acute ischemic stroke with Mg may reduce rates of symptomatic HT.
In this post hoc study of the Field Administration of Stroke Therapy Magnesium (FAST-MAG) trial, 1,245 participants with a diagnosis of cerebral ischemia received 20 g of Mg or placebo initiated in the prehospital setting. Posttreatment serum Mg level was measured for 809 participants. Cases of clinical deterioration, defined as worsening by ≥4 points on the National Institute of Health Stroke Scale (NIHSS), were imaged and evaluated for etiology. Symptomatic HT was defined as deterioration with imaging showing new hemorrhage.
Clinical deterioration occurred in 187 and symptomatic HT in 46 of 1,245 cases of cerebral ischemia. Rates of deterioration and symptomatic HT were not significantly lower in those who received Mg (15.7% vs. 14.4%, p = 0.591; 2.8% vs. 4.6%, p = 0.281). In cases where serum Mg level was obtained posttreatment, lower serum Mg level (<1.7 mg/dL) was associated with significantly higher rates of deterioration and symptomatic HT (27.5% vs. 15.5%, p = 0.0261; 11.6% vs. 3.65%, p = 0.00819).
Treatment with Mg did not significantly reduce rates of clinical deterioration or symptomatic HT. Future analysis should address whether treatment with Mg could have influenced the subgroup with low serum Mg at baseline.
镁（Mg）是临床前模型中的神经保护剂。较低的血清镁水平与缺血性脑卒中患者的症状性出血性转化（HT）相关。早期使用镁治疗急性缺血性脑卒中可能会降低症状性 HT 的发生率。
本研究为 FAST-MAG 试验的事后分析，共纳入 1245 名诊断为脑缺血的患者，在院前环境中接受 20g 的镁或安慰剂治疗。对 809 名参与者进行了治疗后血清镁水平的检测。将临床恶化定义为国立卫生研究院卒中量表（NIHSS）评分增加≥4 分的病例，进行影像学检查并评估病因。症状性 HT 定义为影像学显示新出血的恶化。
1245 例脑缺血患者中，187 例出现临床恶化，46 例出现症状性 HT。接受镁治疗的患者恶化和症状性 HT 的发生率无显著差异（15.7%比 14.4%，p=0.591；2.8%比 4.6%，p=0.281）。在获得治疗后血清镁水平的病例中，较低的血清镁水平（<1.7mg/dL）与更高的恶化和症状性 HT 发生率相关（27.5%比 15.5%，p=0.0261；11.6%比 3.65%，p=0.00819）。
镁治疗并未显著降低临床恶化或症状性 HT 的发生率。未来的分析应探讨镁治疗是否会影响基线时血清镁水平较低的亚组。
