BACKGROUND Magnesium (Mg) and calcium (Ca) are the principal essential elements involved in endothelial cell homeostasis. Extracellular changes in the levels of either alter endothelial contraction and dilatation. Consequently Mg and Ca imbalance is associated with a high risk of endothelial dysfunction, the main process observed during acute aortic dissection (AAD); in this clinical condition, which mainly affects elderly men, smooth muscle cell alterations lead to intimal tears, creating a false new lumen in the media of the aorta. AAD patients have a high risk of mortality as a result of late diagnosis because often it is not distinguished from other cardiovascular diseases. We investigated Mg and Ca total circulating levels and the associated pro-inflammatory mediators in elderly AAD patients, to gain further information on the pathophysiology of this disorder, with a view to suggesting newer and earlier potential biomarkers of AAD. RESULTS Total circulating Mg and Ca levels were both lower in AAD patients than controls (p < 0.0001). Using Ca as cut-off, 90% of AAD patients with low Ca (<8.4 mg/dL) came into the type A classification of AAD. Stratifying AAD according to this cut-off, Mg was lower in patients with lower total Ca. Compared to controls, both type A and B AAD patients had higher levels of all the pro-coagulant and pro-inflammatory mediators analyzed, including sP-sel, D-dimer, TNF-α, IL-6, and CRP (p < 0.05). Dividing types A and B using the Stanford classification, no significant differences were found (p > 0.05) The levels of both ICAM-1 and EN-1 were lower in AAD than in a control group (p < 0.0001 and p < 0.05 respectively). CONCLUSIONS These findings suggest that low Mg and Ca in AAD elderly patients may contribute to altering normal endothelial physiology and also concur in changing the normal concentrations of different mediators involved in vasodilatation and constriction, associated with AAD onset and severity.

中文翻译：

---

老年急性主动脉夹层患者镁和钙失衡的初步观察性研究。

背景技术镁（Mg）和钙（Ca）是涉及内皮细胞稳态的主要必需元素。细胞外水平的改变会改变内皮的收缩和扩张。因此，镁和钙的失衡与内皮功能异常的高风险有关，内皮功能异常是急性主动脉夹层（AAD）期间观察到的主要过程。在这种主要影响老年男性的临床状况下，平滑肌细胞改变导致内膜撕裂，在主动脉中部形成假的新管腔。由于晚期诊断常常导致AAD患者与其他心血管疾病没有区别，因此其死亡风险很高。我们调查了老年AAD患者的镁和钙总循环水平以及相关的促炎介质，以获得有关这种疾病的病理生理学的进一步信息，以期提出更新和更早的潜在AAD生物标志物。结果AAD患者的总循环Mg和Ca水平均低于对照组（p <0.0001）。使用钙作为临界值，低钙（<8.4 mg / dL）的AAD患者中有90％进入AAD的A型分类。根据该临界值分层AAD，总Ca较低的患者中Mg较低。与对照组相比，A型和B型AAD患者的所有促凝和促炎性介质（包括sP-sel，D-二聚体，TNF-α，IL-6和CRP）的含量均较高（p <0.05 ）。使用斯坦福分类法将A型和B型划分为无明显差异（p> 0.05）AAD中ICAM-1和EN-1的水平均低于对照组（p <0。0001和p <0.05）。结论这些发现表明，AAD老年患者的低Mg和Ca可能有助于改变正常的内皮生理，并且还有助于改变与AAD发作和严重程度相关的血管舒张和收缩的不同介质的正常浓度。