Kim Moinay, Park Wonhyoung, Hwang Jun Ha, Kim Jae Hyun, Chung Yeongu, Lee Si Un, Byun Joonho, Park Jung Cheol, Ahn Jae Sung, Lee Seungjoo
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2025 Apr 14;40(14):e45. doi: 10.3346/jkms.2025.40.e45.
Serum calcium and magnesium levels are a key factor of the coagulation cascade and may potentially contribute to the pathophysiology of intracerebral hemorrhage (ICH) expansion. The aim of this study was to attain and sustain target levels of serum calcium and magnesium for three days following admission.
A single-blind, prospective, multicenter randomized study was conducted from 2019 to 2022 years, enrolling acute ICH patients aged 18-80 years, with radiological diagnosis and without surgical intervention. Participants were randomly assigned in a 1:1 ratio to either the study group or the control group. In the study group, the target serum levels of calcium (9-10.2 mg/dL) and magnesium (2-3 mg/dL) were actively achieved and maintained for a duration of 3 days following admission. The primary outcome was the expansion of ICH volume within the first 3 days between the study group and the control groups.
After implementing inclusion/exclusion criteria, 105 of 354 patients remained in the study. There were no significant differences in ICH volume on hospital days 2 and 3 between the groups. Admission factors including Glasgow coma scale score, hemoglobin level, ICH volume, and spot sign showed significant correlations in multivariate analysis. On the third day of hospitalization, admission serum magnesium levels showed a significant correlation with ICH expansion, whereas calcium levels did not.
Admission serum magnesium levels were found to correlate with hematoma expansion in patients with acute ICH. While magnesium itself may not be a direct therapeutic target, it could serve as a valuable indicator for identifying potential therapeutic strategies aimed at preventing ICH volume increase.
Clinical Research Information Service Identifier: KCT0004427.
血清钙和镁水平是凝血级联反应的关键因素，可能在脑出血（ICH）扩大的病理生理过程中发挥作用。本研究的目的是在入院后三天内达到并维持血清钙和镁的目标水平。
2019年至2022年进行了一项单盲、前瞻性、多中心随机研究，纳入年龄在18 - 80岁、经影像学诊断且无需手术干预的急性ICH患者。参与者按1:1比例随机分为研究组或对照组。在研究组中，积极实现并维持血清钙（9 - 10.2mg/dL）和镁（2 - 3mg/dL）的目标水平，持续至入院后3天。主要结局是研究组和对照组在最初3天内ICH体积的扩大情况。
在实施纳入/排除标准后，354例患者中有105例留在研究中。两组在住院第2天和第3天的ICH体积无显著差异。多因素分析显示，包括格拉斯哥昏迷量表评分、血红蛋白水平、ICH体积和斑点征在内的入院因素具有显著相关性。在住院第三天，入院时血清镁水平与ICH扩大显著相关，而钙水平则无此相关性。
发现急性ICH患者入院时血清镁水平与血肿扩大相关。虽然镁本身可能不是直接的治疗靶点，但它可作为识别旨在预防ICH体积增加的潜在治疗策略的有价值指标。
临床研究信息服务标识符：KCT0004427。
