硒对经^131I治疗Graves病患者血清甲状腺过氧化物酶抗体水平的影响

Effect of additional selenium on the levels of serum thyroid peroxidase antibody in patients with Graves disease treated with ^131I

目的 探讨Graves病患者经^131I治疗后,补硒对患者血清甲状腺过氧化物酶抗体（TPOAb）水平的影响.方法 选取TPOAb水平为10～ 1300 IU/ml的Graves病患者266例,其中,TPOAB范围在10～60 IU/ml为阴性,TPOAb＞60 IU/ml为阳性.将所有患者随机分成对照组（112例）和硒治疗组（154例）,对照组经131I治疗后行常规治疗,硒治疗组经^131I治疗后行常规治疗及服硒制剂（100μg/次,2次/d）,比较两组治疗后6、12个月TPOAb水平及TPOAb阳性率的变化.结果 治疗后6个月,两组TPOAb水平较治疗前均明显上升,且差异有统计学意义（对照组：Z=-2.084,P＜0.05;硒治疗组：Z=-2.112,P＜0.05）,但两组之间的差异无统计学意义（Z=-0.764,P＞0.05）;治疗后12个月,对照组TPOAb水平与治疗前相比差异无统计学意义（Z=-1.538,P＞0.05）,硒治疗组TPOAb水平与治疗前相比差异有统计学意义（Z=-5.465,P＜0.01）,两组间比较差异有统计学意义（Z=-2.180,P＜0.05）;两组TPOAb水平阳性率在治疗后6、12个月与治疗前相比无明显变化（对照组：χ^21=0.720、χ^22=0.103,P均＞0.05;硒治疗组：χ^21=0.023、χ^22=0.340,P均＞0.05）,两组间比较差异亦无统计学意义（χ^21=0.001、χ^22=0.366,P均＞0.05）.结论 补硒能有效降低经^131I治疗的Graves病患者的血清TPOAb水平,对血清高水平TPOAb的降低尤为明显.

Objective To explore the effect of additional selenium on the serum levels of thyroid peroxidase antibody （TPOAb） after treatment of Graves disease with ^131I.Methods A total of 266 patients with TPOAb levels between 10 and 1300 IU/ml participated in this study.TPOAb levels within 10 IU/ml to 60 IU/ml were considered negative,and levels greater than 60 IU/ml were considered positive.All patients were randomly divided into control （n=112） and selenium treatment group （n=154）.After treatment with 131I,the control group received conventional therapy,whereas the selenium treatment group received additional selenium （100 μg twice a day）.The TPOAb levels and positive ratios of the two groups were compared with pre-therapy levels after treatment for 6 and 12 months.Results After 6 months,the TPOAb levels in both groups significantly increased compared with the pre-therapy levels （control group：Z=-2.084,P〈0.05;selenium treatment group：Z=-2.112,P〈0.05）.However,no significant difference existed in the TPOAb levels between the two groups （Z=-0.764,P〉0.05）.After 12 months,the TPOAb levels in the control group did not change significantly compared with the pre-therapy levels（Z=-1.538,P〉 0.05）,whereas the TPOAb levels in the selenium treatment group significantly decreased compared with the pre-therapy levels （Z=-5.465,P〈0.01）.The difference between the two groups were statistically significant （Z=-2.180,P〈0.05）.The positive ratios of TPOAb for both groups did not change significantly 6 or 12 months after ^131I therapy （control group：χ^21 =0.720,χ^22 =0.103,both P〉0.05;selenium treatment group：χ^21 =0.023,χ^22 =0.340,both P〉0.05）.Overall,the positive ratios were not statistically significant between the two groups （χ^21=0.001,χ^22=0.366,both P〉0.05）.Conclusion Additional treatment with selenium after ^131I therapy for Graves disease can effectively decrease the TPOAb levels,especially for patients with high initial TPOAb levels.