Promjene koncentracije magnezija u serumu bolesnika s upalom sluznice probavnoga sustava kao posljedicom kemoterapije [Changes in serum concentration of magnesium in patients with chemotherapy induced alimentary tract mucositis]

Grubišić-Čabo, Filip (2013) Promjene koncentracije magnezija u serumu bolesnika s upalom sluznice probavnoga sustava kao posljedicom kemoterapije [Changes in serum concentration of magnesium in patients with chemotherapy induced alimentary tract mucositis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Aim an purpose of the study Primary objectives of the study were to establish, in the group of patients with chemotherapy induced alimentary tract mucositis gr.III/IV: the level of total serum magnesium, possible correlation between total serum magnesium level and granulocytopenia, and possible clinical signs of hypomagnesemia in the presence of low serum magnesium level! Secondary objectives of the study were to establish in the group of patients with hypomagnesemia, in all patient with chemotherapy induced mucositis regardless of grade, possible electrocardiographic abnormalities as well as total serum calcium levels! The purpose of the study was to determine the incidence of hypomagnesemia, as well as possible correlation with other parameters which were followed. ----- Examinees and Methods Two hundred and twenty six patients with chemotherapy induced alimentary tract mucositis, aged 18 years and more, were included in this prospective study. They were divided in two subgroups. In the first group were those who had alimentary tract mucositis grade III/IV, and in the second those who had mucositis grade I/II. Possible clinical symptoms, or signs, of hypomagnesemia were estimated due to the presence, or absence, of weakness and/or neurological deficits. Electrocardiograms were made with machine General Electric MAC 500, and serum magnesium levels were determined with analyzers ADVIA 1200- Siemens, with modified xylidyl blue method. ----- Results Twenty- eight among hundred and thirteen patients (24,77%) which had chemotherapy induced alimentary mucositis, grade III/IV, also had hypomagnesemia. In that group od patients correlation between hypomagnesemia and granulocytopenia was statistically significant ( hi-kvadrat=12.535, p=0.0004). There were no statistically significant differences regarding clinical symptoms, or signs, between patients with or without hypomagnesemia ( hi-kvadrat= 1.189, p= 0.276). Statistically significant correlation was determined between total serum magnesium and calcium concentration levels( /R=0,60/; p<0,001). In one part of patients with hypomagnesemia, regardless of severity of alimentary tract mucositis, abnormalities in electrocardiograms were found, but larger clinical trials should be done to confirm it. ----- Conclusion Among patients with chemotherapy induced grade III/IV alimentary tract mucositis, 24,77% also had hypomagnesemia. The correlation between hypomagnesemia and granulocytopenia, as well as total serum magnesium and calcium concentration levels, were confirmed in that group of patients. There were no difference in the same group of patients, regarding presence of weakness and/or neurological deficits, between patients with hypomagnesemia and those who had serum magnesium concentration level within normal range.

Abstract in Croatian

Ciljevi i svrha rada Ova je prospektivna studija imala primarne i sekundarne ciljeve istraživanja. Primarni ciljevi istraživanja bili su odrediti, pri prvom prezentiranju ispitanika sa kliničkim simptomima kemoterapijom uzrokovane upale sluznice cijelog probavnog sustava stupnja III/IV: visinu ukupnog magnezija u serumu; zatim odrediti korelaciju eventualne hipomagnezemije te granulocitopenije; te odrediti eventualno prisustvo kliničkih simptoma hipomagnezemije kod zabilježenih niskih vrijednosti magnezija u serumu! Sekundarni ciljevi istraživanja sastojali su se u određivanju, kod svih bolesnika sa upalom sluznice probavnog sustava neovisno o stupnju upale te prisutnom hipomagnezemijom, eventualnog prisustva odstupanja od normale u elektrokardiogramu, te određivanju ukupnog kalcija u serumu. Svrha disertacije jest u tom kako bi se utvrdila učestalost i eventualna korelacija hipomagnezemije te ostalih praćenih parametara. ----- Ispitanici i metode U ovo ispitivanje se uključilo 226 punoljetna bolesnika sa kliničkim simptomima kemoterapijom uzrokovane upale sluznice cijelog probavnog sustava. Ispitanici su podijeljeni u dvije skupine sa po 113 ispitanika. U prvoj skupini su bili oni koji su imali upalu sluznice cijelog probavnog sustava stupnja III/IV, a u drugoj oni koji su imali upalu stupnja I/II. Eventualno prisustvo kliničkih simptoma hipomagnezemije se određivalo na temelju prisustva, odnosno odsustva, slabosti i/ili neuroloških ispada. Elektrokardiogram se snimao na aparatima General Electric MAC 500, a vrijednosti magnezija u serumu su se određivale na analizatorima ADVIA 1200- Siemens, metodom modificirane reakcije ksilidil plavila. ----- Rezultati Dio bolesnika, 28/113 (24,77%), sa kemoterapijom izazvanom upalom sluznice stupnja III/IV, imalo je i hipomagnezemiju. U istih ispitanika povezanost hipomagnezemije i granulocitopenije je bila statistički značajna ( hi-kvadrat=12.535, p=0.0004). Nije bilo statistički značajne razlike u prisustvu kliničkih simptoma među ispitanicima koji su imali hipomagnezemiju te onih kod kojih je vrijednost magnezija u serumu bila unutar granica normale ( hi-kvadrat= 1.189, p= 0.276). Kod tih bolesnika utvrdila se statistički značajna povezanost između vrijednosti ukupnog magnezija i kalcija u serumu( /R=0,60/; p<0,001). U dijela ispitanika sa hipomagnezemijom, neovisno o stupnju upale sluznice probavnog sustava, našla su se odstupanja od normale u elektrokardiogramu, ali su potrebne veće kliničke studije kako bi se potvrdili ovi rezultati istraživanja. ----- Zaključak Među bolesnicima sa kemoterapijom izazvanom upalom sluznice cijelog probavnog sustava, stupnja III/IV, 24,77% ih je imalo i hipomagnezemiju. Postoji povezanost hipomagnezemije i granulocitopenije te vrijednosti koncentracija ukupnog magnezija i kalcija u serumu. Nije utvrđena razlika u prisustvu slabosti i/ili neuroloških deficita, između onih koji imaju hipomagnezemiju i onih kod kojih je vrijednost koncentracije magnezija u serumu bila unutar granica normale, kod istih bolesnika.

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