硒在^(131)I治疗Graves′病后甲状腺功能减退伴TPOAb和TGAb增高患者中的临床应用研究

Clinical application of selenium on patients with Graves′ disease accompany with hypothyroidism and increase of TPOAb and TGAb after treating with ^(131)I

目的评价硒在^(131)I治疗Graves′病后甲状腺功能减退伴甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)增高患者中的疗效,观察补充硒后患者TPOAb和TGAb的变化。方法选取2015年1月至2016年12月昆明医科大学第二附属医院核医学科门诊及住院的120例患者,分为对照组和观察组各60例。对照组患者采用左旋甲状腺素(LT4)治疗,观察组患者采用LT4联合硒酵母200μg口服,每天2次,共6个月。比较两组患者治疗前、治疗6个月的甲状腺激素、甲状腺抗体水平和血清硒浓度的变化。结果治疗前和治疗6个月两组患者血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺素(FT4)、高敏促甲状腺激素(s TSH)水平比较,差异均无统计学意义(P>0.05);治疗6个月后,观察组患者TPOAb和TGAb水平明显低于对照组,血清硒浓度明显高于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析显示,观察组患者TPOAb、TGAb的变化与血清硒浓度呈显著负相关(r=-0.945,P<0.01)。结论补硒治疗可以降低Graves′病伴TPOAb和TGAb增高患者行^(131)I治疗后的TPOAb和TGAb水平,减轻甲状腺自身免疫反应。

Objective To study the clinical effects of selenium supplement in patients with Graves′ disease accompany with hypothyroidism and increase of TPOAb and TGAb after treating with^(131)I. Methods A total of 120 in-and out-patients,who were in the Department of Nuclear Medicine of the Second Affiliated Hospital of Kunming Medical University from January 2015 to December 2016,were selected and divided into the control group and the observation group,60 cases in each group. The control group was adopted with levothyroxine(LT4),while the observation group was adopted with LT4 combined with selenium supplement 200 μg orally,twice a day for 6 months. The levels of thyroid hormone,changes of thyroid antibodies and concentrations of serum selenium before treatment and after 6-month treatment in both groups were compared. Results The levels of serum T3,T4,FT3,FT4 and s TSH in both groups before treatment and after 6-month treatment showed no statistically significant difference(P>0.05). After 6-month treatment,the levels of TPOAb and TGAb in the observation was obviously lower than those in the control group,but the concentration of serum selenium was obviously higher than that in the control group,the difference had statistical significance(P<0.05). The Pearson correlation analysis showed that the changes of TPOAb and TGAb in the observation group were significantly negatively correlated with the concentrations of serum selenium(r=-0.945,P<0.01). Conclusion Selenium supplement can reduce the levels of TPOAb and TGAb in patients with Graves′ disease after^(131)I treatment,and alleviate the thyroid autoimmune reaction.