入院时血清镁水平不能预测急性心肌梗死患者的住院结局。
Admission serum magnesium level does not predict the hospital outcome of patients with acute myocardial infarction.
作者信息
Madias J E, Sheth K, Choudry M A, Berger D O, Madias N E
机构信息
Mount Sinai School of Medicine, City University of New York, NY, USA.
出版信息
Arch Intern Med. 1996;156(15):1701-8.
OBJECTIVE
To establish whether hypomagnesemia at admission predicts excessive morbidity, particularly cardiac arrhythmias, and mortality in patients with acute myocardial infarction.
METHODS
We compared hypomagnesemic and normomagnesemic patients with acute myocardial infarction in 517 patients admitted to the coronary care unit. The serum magnesium concentration, along with a large array of other parameters, was measured on admission to the emergency department. Other baseline attributes and variables related to the patients' hospital course were used to compare the 2 groups.
RESULTS
The 132 patients (25.9%) with low serum magnesium concentrations at admission (mean +/- SD, 0.61 +/- 0.06 mmol/L [1.48 +/- 0.15 mg/dL]) were comparable to the patients with normal serum magnesium concentrations (0.81 +/- 0.11 mmol/L [1.96 +/- 0.26 mg/dL]) except for a higher rate of prehospital use of diuretic agents (32.6% vs 22.5%, P = .02) and earlier presentation after onset of symptoms (mean +/- SD, 3.2 +/- 4.1 vs 4.8 +/- 6.6 hours, P = .003). There was no correlation between serum magnesium and potassium concentrations in the emergency department (r = 0.14). No difference was detected between the hypomagnesemic and normomagnesemic cohorts in rates of total mortality (18.9% vs 18.5%, P = .91), cardiac mortality (15.2% vs 15.3%, P = .99), atrial fibrillation (13.6% vs 13.8%, P = .97), ventricular tachycardia (18.2% vs 15.3%, P = .44), or ventricular fibrillation (15.2% vs 13.5%, P = .63). Management of the 2 cohorts was not different, except for higher rates of use of magnesium (17.4% vs 1.3%, P < .001) and potassium (59.8% vs 42.1%, P < .001) supplements and antiarrhythmic drugs (62.9% vs 48.7%, P = .005) in the hypomagnesemic patients. An endogenous rise in serum magnesium level was documented in a subgroup of 161 patients who had a repeated measurement (0.74 +/- 0.12 mmol/L [1.79 +/- 0.29 mg/dL] in the emergency department vs 0.77 +/- 0.09 mmol/L [1.88 +/- 0.23 mg/dL] in the coronary care unit, P < .001).
CONCLUSIONS
We conclude that hypomagnesemia is seen in approximately one fourth of patients with myocardial infarction, is not linked to hypokalemia, has some relationship to preadmission use of diuretic agents, is associated with early presentation to the hospital, and is not a predictor of increased morbidity or mortality.
目的
确定入院时低镁血症是否可预测急性心肌梗死患者的过度发病情况，尤其是心律失常以及死亡率。
方法
我们对收入冠心病监护病房的517例急性心肌梗死患者中的低镁血症患者和正常镁血症患者进行了比较。在急诊科入院时测定血清镁浓度以及一系列其他参数。使用其他基线特征和与患者住院过程相关的变量对两组进行比较。
结果
入院时血清镁浓度低的132例患者（25.9%）（均值±标准差，0.61±0.06 mmol/L [1.48±0.15 mg/dL]）与血清镁浓度正常的患者（0.81±0.11 mmol/L [1.96±0.26 mg/dL]）相比，除院前利尿剂使用率较高（32.6% 对22.5%，P = 0.02）以及症状发作后就诊较早（均值±标准差，3.2±4.1对4.8±6.6小时，P = 0.003）外，两者具有可比性。急诊科血清镁与钾浓度之间无相关性（r = 0.14）。低镁血症组和正常镁血症组在总死亡率（18.9% 对18.5%，P = 0.91）、心脏死亡率（15.2% 对15.3%，P = 0.99）、心房颤动（13.6% 对13.8%，P = 0.97）、室性心动过速（18.2% 对15.3%，P = 0.44）或心室颤动（15.2% 对13.5%，P = 0.63）发生率方面未检测到差异。两组的治疗无差异，只是低镁血症患者使用镁补充剂（17.4% 对1.3%，P < 0.001）、钾补充剂（59.8% 对42.1%，P < 0.001）和抗心律失常药物（62.9% 对48.7%，P = 0.005）的比例较高。对161例进行了重复测量的患者亚组记录到血清镁水平的内源性升高（急诊科为0.74±0.12 mmol/L [1.79±0.29 mg/dL]，冠心病监护病房为0.77±0.09 mmol/L [1.88±0.23 mg/dL]，P < 0.001）。
结论
我们得出结论，约四分之一的心肌梗死患者存在低镁血症，与低钾血症无关，与入院前使用利尿剂有一定关系，与较早入院有关，且不是发病率或死亡率增加的预测因素。
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