血硒对慢性肾功能衰竭患者脂质代谢的影响

Correlation of blood selenium levels with lipid metabolism in patients with chronic renal failure

目的探讨血硒对慢性肾功能衰竭(CRF)患者血清脂质代谢的影响及其机制。方法采用原子荧光光谱、放射免疫、生化比色、比浊和化学发光法对40例CRF患者和30例正常对照者的全血硒、血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、超敏促甲状腺激素(s-TSH)、全段甲状旁腺激素(iPTH)、TC、TG、HDL-C、LDL-C、载脂蛋白A(ApoA)和载脂蛋白B(ApoB)的含量进行测定,同时检测肾功能等生化指标;并采用多元logistic回归分析血硒与血脂、甲状腺激素(TH)及TH与血肌酐、血脂的相关性。结果CRF患者全血硒含量和血清TT3、FT3、TT4、FT4、HDL-C均明显低于对照组(P<0.01或0.05);血清TG、LDL-C、ApoB和iPTH明显高于对照组(P<0.01或0.05)。CRF患者血硒与TT3、FT3、HDL-C呈显著正相关,而与iPTH、TG、LDL-C、ApoB呈显著负相关;血清TT3、FT3与Scr、TG、LDL-C、ApoB呈显著负相关,而与HDL-C呈显著正相关。结论低血硒可能通过影响CRF患者TH与PTH代谢,从而导致脂质代谢紊乱。

Objective To investigate the correlation of blood selenium levels with serum lipid metabolism in patients with chronic renal failure （CRF）. Methods Blood selenium, TC, TG, HDL-C, LDL-C, apolipoprotein A （Apo A）, apolipoprotein B （Apo B）, serum total triiodothyronine （TT3）, total thyroxine （TT4）, free-T3 （FT3）, free-T4 （ FT4 ）, super-thyrotropin （s-TSH）, intact parathyroid hormone （ iPTH ）,serum creatinine, urea nitrogen and uric acid concentrations were simultaneously measured in 40 patients with CRF as well as in 30 normal controls （NC）. The relation between above parameters and the change of blood selenium was analyzed by multiple logistic regression. Results The selenium in whole blood,serum TT3, TT4, FT3, FT4 and HDL-C concentrations in patients with CRF were significantly lower than those in NC （P〈0.01 or〈0.05 respectively）;CRF patients had significantly higher serum TG, LDL-C, ApoB and iPTH ievels than those in NC （P〈0.01 or 〈0.05, respectively）. Multiple logistic regression analysis showed that content of selenium in whole blood in CRF patients was positively correlated with serum TT3, FT3 and HDL-C concentrations and negatively correlated with iPTH, TG, LDL-C and ApoB. There were negative correlation between TT3 or FT3 and serum creatinine or TG LDL-C or apoB, positive correlation between TT3 or FT3 and HDL-C. Conclusion Microelement selenium deficiency may result in the lipid metabolic disorder of CRF patients, which may be related to TH and iPTH metabolism.