| <P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">新西兰药品和医疗器械安全管理局（</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Medsafe</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">）在其发布的</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">2010</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">年第</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">2</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">期《</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Prescriber Update</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">》中提醒医疗专业人员，已经发现使用奥美拉唑和低镁血症之间有关联。含奥美拉唑的药品信息正在更新过程中。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??"></SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">低镁血症的安全性信号是从服用奥美拉唑患者的不良事件报告中发现的。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">2008</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">年，新西兰不良反应监测中心（</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">CARM</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">）发现了</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">2</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">例低镁血症和低钙血症的病例报告，但当时证据不足，无法证明其与奥美拉唑之间的关联性。从那以后，越来越多的证据都证明了这一关联性，包括报告给</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">CARM</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">的另</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">1</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">例低镁血症病例、文献</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">[1-3]</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">中发表的病例报道以及荷兰药物警戒中心报告的病例</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">[4]</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??"></SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">多数低镁血症病例报告与奥美拉唑的长期用药（正常剂量</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">20-40 mg/d</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">）有关；停止治疗后血镁水平恢复正常。低镁血症病例通常也伴有低钙血症，有些患者有重度低钙血症及低镁血症的症状表现（惊厥、心律失常、手足抽搐、严重呕吐导致其他电解质紊乱和精神病症状）。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??"></SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">镁可能通过减少甲状旁腺激素分泌，降低骨骼肌和肾脏组织对甲状旁腺激素的反应性，从而对体内钙的稳态产生影响</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">[4]</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">。虽然奥美拉唑引起低镁血症的机制不明，但据推测可能是因为通过主动运输机制吸收的镁减少导致</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">[1]</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??"></SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Medsafe</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">提醒医疗专业人员，服用奥美拉唑的患者如果出现肌肉痉挛、虚弱无力、易激惹或意识不清等症状，要警惕低镁血症的可能性。</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??"></SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 28.1pt" align=left><B><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">参考文献：<SPAN></SPAN></SPAN></B></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">1</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">．</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Cundy T, Dissanayake A 2009. Severe hypomagnesaemia in long-term users of proton-pump inhibitors Clin Endocrinol.(Oxf.) 69(2): 338-41.</SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">2</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">．</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Epstein M, McGrath S, Law F 2006. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism N Engl J Med 355(17): 1834-6.</SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">3</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">．</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">Shabajee N, Lamb EJ, Sturgess I, Sumathipala RW 2008. Omeprazole and refractory hypomagnesaemia BMJ 337: a425.</SPAN></P>
<P style="TEXT-ALIGN: left; LINE-HEIGHT: 150%; TEXT-INDENT: 31.5pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">4</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 宋体">．</SPAN><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: ??">The Netherlands Pharmacovigilance Centre. 2009. <A href="http://www.lareb.nl/%20documents/kwb_2009_2_omepr.pdf"><SPAN style="COLOR: windowtext; TEXT-DECORATION: none; text-underline: none">http://www.lareb.nl/ documents/kwb_2009_2_omepr.pdf</SPAN></A></SPAN></P> |
