小儿弱视与微量元素硒的关系及其临床意义

The relationship between amblyopia in children and trace element selenium and clinical significance

目的:观察微量元素硒及相关生物活性物质对小儿弱视影响以及硒治疗的效果。方法:将弱视患儿随机分为两组:在常规使用遮盖加精细目力训练的基础上,A组37例患儿口服亚硒酸钠0.5 mg/d,连服1周,以后每周0.5 mg,疗程6个月;B组31例患儿未服用亚硒酸钠。观察对象分别于治疗前和治疗6个月后抽血检测血清硒(Se)、血浆谷胱甘肽过氧化物酶(GSH-PX)活力及丙二醛(MDA)含量等指标,随访1年,以观察远期疗效。结果:治疗后A组血清Se(0.034±0.016)mg/L明显高于治疗前(0.013±0.008)mg/L,差异有显著性(P<0.01);A组血浆GSH-PX活力为(87.12±13.61)IU/L,较治疗前(53.62±18.70)IU/L明显增加,差异有显著性(P<0.01)。A组MDA含量(6.46±1.55)nmol/m l,较治疗前(8.68±1.49)nmol/m l明显降低,差异有显著性(P<0.05)。血清Se与血浆GSH-PX呈正相关(r值=0.781,P<0.01),与MDA呈负相关(r值=-0.385,P<0.05)。患儿视力恢复正常者A组22例(59.46%),B组11例(35.48%);视力进步者A组12例(32.43%),B组12例(38.71%);视力恢复率A组明显高于B组(2χ值=3.896,P<0.05),远期疗效较好。结论:用亚硒酸钠治疗该地区弱视患儿有明显的治疗效果;Se水平低表明该地区小儿弱视可能与缺硒有关。提示补充适量硒可提高该地区因低硒引起的弱视患儿的视力。

Objective： To investigate the effects of trace element selenium and related bioactive substances in children with amblyopia in several regions of Lanzhou and to evaluate the therapeutic effects of sodium selenite. Methods： 68 patients with amblyopia were divided into A group （ n = 37） and B group （ n = 31 ）. 68 patients were treated with therapeutic physical exercises. 37 cases in A group were treated with O. 5 mg day - 1 sodium selenite for one week, then 0. 5 mg week -1 for 6 months. 31 cases in B group were not treated with sodium selenite. Serum selenium （Se） , plasma glutathione pexoxidase （GSH- Px） and plasma malondialdehyde （MDA） were determined before and after treatment . The samples were stored at -40℃ and analyzed within 6 months. During 1 year of follow - up study, the therapeutic effects in two groups were observed. Results： After 6 months treatment, the serum Se and plasma GSH - Px levels in A group were significantly higher [（0. 034±0. 016） mg/L vs（0.013±0.008）mg/L, （87.12 ± 13. 61） U/L vs （53.62±18.70）U/L, respectively, P〈0. 01]. The plasma MDA （6.46± 1.55） nmol/ml vs （8.68 ± 1.49） nmol/ml levels in A group were obviously decreased （ P 〈0.05 ）. The levels of plasma GSH - Px was positively correlated with the serum Se （ r = 0. 781 , P 〈0. 01 ）. The levels of plasma MDA were negatively correlated with the serum Se （ r = - 0. 385, P 〈 0. 05 ）. The effective rate of visual function in two group were 91. 89% and 74. 19%, respectively. Compared A group with B group, there were significantly difference （χ^2= 3. 896, P 〈 0. 05 ）. Conclusion： Treating amblyopia in children 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 amblyopia. Therefore, Selenium may be helpful to treatment and prevention of the Se - deficient children with amblyopia.