硒对桥本甲状腺炎的临床疗效及氧化抗氧化系统的作用

周路路; 金国玺; 吕高友; 王春; 李娟

doi:10.13898/j.cnki.issn.1000-2200.2019.11.009

硒对桥本甲状腺炎的临床疗效及氧化抗氧化系统的作用

Effect of selenium on the clinical efficacy and oxidant/antioxidant system in Hashimoto thyroiditis

摘要

摘要:
目的研究硒干预治疗桥本甲状腺炎（HT）的临床疗效及其对HT氧化抗氧化系统的影响。
方法60例HT受试者随机分为A组和B组，再分为甲状腺功能（甲功）正常的A1、B1亚组和甲状腺功能减退（甲减）的A2、B2亚组。B组予以左甲状腺素钠片替代治疗，A组采用左甲状腺素钠片加硒酵母治疗，共3个月。30名健康体检者为正常对照（NC组）。比较各组治疗前后血硒水平、甲状腺功能总三碘甲状腺原氨酸（TT3）、甲状腺素（TT4）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）、氧化指标（MDA）、抗氧化指标（GPX）的变化以及分析各指标间相关性。
结果治疗前，HT病人血硒水平明显低于NC组（P < 0.01），其中甲减组又低于甲功正常组（P < 0.05）；治疗后，A组升高（P < 0.05），B组无明显变化（P>0.05）。治疗后，A2、B2亚组TSH水平降低（P < 0.05），其余各组甲状腺功能变化差异无统计学意义（P>0.05）；治疗后A组TPOAb、TgAb水平总体上明显降低（P < 0.01），而B组无明显变化（P>0.05）；治疗前，HT病人MDA水平高于NC组（P < 0.05），而GPX活性低于NC组（P < 0.05）；治疗后，A组总体上MDA水平降低（P < 0.05），同时GPX活性明显升高（P < 0.01），而B组两个指标变化不明显（P>0.05）；治疗前，HT病人血硒水平与TT4呈正相关关系（r=0.294，P < 0.05），与TSH呈负相关关系（r=-0.343，P < 0.01），其余指标间无明显相关性（P>0.05）。
结论HT病人血硒水平低于健康人群，硒酵母可降低病人甲状腺自身抗体滴度，增强机体抗氧化能力，减轻氧化损伤，其联合左甲状腺素钠治疗效果优于单用后者。

Abstract:
ObjectiveTo investigate the effects of selenium intervention on the clinical curativeeffect and oxidative/antioxidant system in Hashimoto thyroiditis(HT).
MethodsSixty cases with HT were randomly divided into the selenium group(group A) and levothyroxine group(group B), and further divided into the A1 and A2 subgroups(euthyroidism), and B1 and B2 subgroups(hypothyroidism).Patients in group A and B were both treated with levothyroxine replacement therapy.Besides, patients in group A received particular treatment of selenium geast.Thirty healthy people were set as the normal control group(NC group).The changes of the serum levels of selenium, TT3, TT4, TSH, thyroid peroxidase antibody(TPOAb), thyroid globulin antibody(TgAb), oxidation index(MDA) and antioxidant index(GPX) in each group were analyzed before and after treatment.And the corretations of the indexes were also analyzed.
ResultsBefore treatment, the serum levels of selenium in HT patients were significantly lower than that in NC group(P < 0.05), and which in hypothyroidism group were lower than that in euthyroidism group(P < 0.05).After treatment, the serum levels of selenium in group A increased greatly(P < 0.05), and there was not obvious change in group B(P>0.05).After treatment, the serum levels of TSH in A2 and B2 groups decreased greatly(P < 0.05), and the difference of the thyroid function in other groups was not statistically significant(P>0.05).After treatment, the levels of TPOAb and TgAb in group A decreased remarkably on the whole(P < 0.01), and the change of which in group B was not obvious(P>0.05).Before treatment, the concentration of MDA and GPX activity in HT patients were higher and lower than that in NC group, respectively(P < 0.05).After treatment, the total serum level of MDA and GPX activity in group A decreased and increased greatly, respectively(P < 0.05), and the changes of two indexes were not obvious in group B(P>0.05).Before treatment, the serum level of selenium was positively correlated with TT4(r=0.294, P < 0.05), and negatively correlated with TSH(r=-0.343, P < 0.01).There was not significant correlation among other indicators(P>0.05).
ConclusionsThe serum level of selenium in HT patients is lower than that in healthy people.The selenium yeast can reduce the levels of thyroid autoantibodies(TPOAb and TgAb), strengthen the antioxidant capacity, and reduce the oxidative damage in HT patients.The treatment effect of selenium combined with levothyroxine is superior to the single use of the latter.

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