硒酵母治疗对自身免疫性甲状腺疾病患者甲状腺自身抗体水平的调节作用

Effect of selenium yeast on the level of thyroid auto-antibodies in patients with autoimmune thyroid diseases

目的评价硒酵母治疗对自身免疫性甲状腺疾病患者甲状腺自身抗体水平的调节效果。方法选取2013年6月—2016年1月期间在复旦大学附属金山医院内分泌科规律就诊随访的弥漫性甲状腺肿伴甲状腺功能亢进(GD)患者64例和桥本甲状腺炎(HT)患者77例。根据治疗方案将GD患者分为对照治疗组28例(甲巯咪唑治疗)和硒补充治疗组36例(甲巯咪唑+硒酵母200μg/d治疗),HT患者亦根据治疗方案分为对照治疗组31例(随访观察甲状腺功能或左甲状腺素钠替代治疗)和硒补充治疗组46例(硒酵母200μg/d或左甲状腺素钠+硒酵母200μg/d治疗)。观察治疗3、6、12、18~24个月时患者甲状腺自身抗体促甲状腺受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)的变化,比较对照治疗组与硒补充治疗组的抗体水平。结果随着治疗时间的延长,两组GD患者TRAb水平逐渐降低,服用甲巯咪唑剂量逐渐减少,HT硒补充治疗组患者TPOAb和TGAb水平均逐渐降低,但其对照组无明显改变。GD硒补充治疗组治疗后6、12、18~24个月的TRAb水平,以及HT硒补充治疗组治疗后6、12、18~24个月的TPOAb和TGAb水平均显著低于相应对照治疗组同时间(P值均<0.05);GD硒补充治疗组治疗后6、12、18~24个月的甲巯咪唑剂量均显著少于对照治疗组(P值均<0.05)。结论硒酵母治疗(200μg/d)对降低GD患者血TRAb浓度、HT患者的血TPOAb和TGAb均有明显效果。

Objective To evaluate the effect of selenium yeast on the level of thyroid auto-antibodies in patients with autoimmune thyroid diseases. Methods Totally 64 Graves disease patients and 77 Hashimoto thyroiditis patients treated in our hospital between June 2013 and January 2016 were recruited in this study. They were allocated into two groups according to different therapies., selenium group （200 pg selenium everyday adding methimazole for Graves disease patients, and 200 μg selenium everyday with or without levothyroxine sodium for Hashimoto thyroiditis patients） and control group （methimazole alone for Graves disease patients, while follow-up with or without levothyroxine sodium for Hashimoto thyroiditis patients）. The levels of thyroid autoantibodies, including thyroid receptor antibody （TRAb）, thyroid peroxidase （TPOAb） and thyroglobulin antibody （TGAb） were compared between the two groups at 3, 6, 12 and 18 to 24 months after treatment. Results TRAb of patients with Grave disease and methimazole dose for Grave disease patients decreased in both Grave disease groups as the treatment lengthened, especially in the selenium group. There was significant difference in TRAb concentration between two groups after 6-months treatment （ P〈0.05）. And methimazole doses decreased more significantly in the selenium group than control group after 6-months treatment （ P〈0.05）, TPOAb and TGAb decreased obviously after six-months treatment in the Hashimoto thyroiditis patients treated by selenium, while no clear change was seen in the control group. Conclusion Selenium yeast treatment （200 μg/d） can effectively decrease serum TRAb in Graves disease patients and TPOAb and TGAb in Hashimoto thyroiditis patients.