小儿大骨节病与微量元素的关系及其临床意义

Relationship between Kaschin-Beck disease in children and trace elements and clinical significance

目的 观察微量元素及相关生物活性物质在小儿大骨节病中的作用及硒对小儿大骨节病的治疗效果。 方法 检测40例大骨节病患儿和30例健康儿童体内7种血清微量元素、血浆谷胱甘肽过氧化物酶(GSH-Px)活力,丙二醛(MDA)水平及相关临床指标。大骨节病组患儿服用亚硒酸钠1.0 mg/d,连服1周,以后每周1.0 mg,疗程6个月。观察治疗前后血清硒(Se)、GSH-Px活力、MDA、骨碱性磷酸酶(BALP)活性、甲状腺激素及免疫球蛋白(IgG、IgA、IgM)等指标,随访1年,以观察远期疗效。结果 治疗后大骨节病组患儿血清Se水平及GSH-Px活力明显增加,MDA显著降低,BALP、IgG和IgM恢复正常。完全缓解者24例(60％),明显好转10例(25％),总有效率达85％。远期疗效较好。结论用亚硒酸钠治疗该地区大骨节病患儿有明显的疗效,Se水平低表明该地区小儿大骨节病可能与缺硒有关,提示临床可适量使用亚硒酸钠。

Objective In order to investigate the effects of trace elements and related bioactive substances in children with Kaschin-Beck disease (KBD) in several regions of Lanzhou and to evaluate the therapeutic effects of sodium selenite. Methods The trace elements, plasma glutathione pexoxidase (GSH-Px),plasma malondialdehyde(MDA) and the other clinical indexes were measured in 40 children with KBD and 30 healthy children. Forty cases of KBD group were treated with sodium selenite at a dose of 1.0 mg/day for one week, then a dose of 1.0 mg/week for 6 months. The serum selenium (Se),GSH-Px,MDA,BALP, thyroid hormones and serum immunoglobulins (IgG,IgA,IgM) were observed before and after treatment. During 1 year of follow-up study,the therapeutic effects in KBD group were observed. Results Se and GSH-Px levels in KBD group were significantly higher after treatment than before treatment (respectively, P < 0.001), and MDA level of KBD group was decreased obviously (P < 0.01). The BALP,IgG and IgM returned to normal level. Complete remission rate was 60%, improving rate was 25%. The total effective rate was 85%. Conclusions Treating KBD patients with sodium selenite demonstrates significant therapeutic effect. It is suggested that the low Se content may help to explain partially of the relation between Se deficiency and KBD. Therefore, it might be suggested that the patients could be treated with sodium selenite.