摘要
目的观察硒对不同甲状腺功能（简称甲功）状态的自身免疫性甲状腺炎（AIT）患者甲状腺过氧化物酶抗体（TPOAb）及其亚型的影响。方法收集2008年6月—2009年6月中国医科大学附属第一医院内分泌科134例15～70岁（平均年龄41岁）TPOAb阳性（〉300U／m1）的AIT患者，根据甲功状态分为亚临床组（89例），临床甲状腺功能减退症（简称甲减）组（45例）。每组患者随机分为补硒组和安慰剂组，补硒组（亚临床组49例，临床甲减组28例）患者每天服用200斗g硒酵母，安慰剂组（亚临床组40例，临床甲减组17例）患者每天服用安慰剂，均服6个月。分别于服药前、服药3个月、服药6个月测定血清TPOAb、血清促甲状腺激素（TSH）、游离甲状腺素（n）、血清硒浓度、TPOAb亚型。结果亚临床组AIT患者补硒3、6个月时TPOAb分别较服药前降低了4．3％和12．6％（均P〈0．05），临床甲减组患者分别较服药前降低了21．9％和20．4％（均P〈0．05）。AIT患者TPOAb亚型以IgG1、IgG3和IgG4为主，阳性率分别是72％、41％和72％。临床甲减组IgG3阳性率及浓度均明显高于亚临床组（均P〈0．05）。补硒后亚临床组的IgG1和IgG3浓度均明显下降（均P〈0．05），甲减组IgG1浓度明显下降（P〈0．05）。77例口服硒酵母的AIT患者中，有52例患者补硒6个月后TPOAb浓度下降，另外25例患者TPOAb浓度未下降或者上升。TPOAb浓度未下降者IgG1业型的阳性率及浓度均明显高于TPOAb浓度下降患者（均P〈0．05）。结论硒可有效降低AIT患者的TPOAb水平，TPOAb以IgG1和IgG3亚型下降为主，高浓度的IgG1可能是导致TPOAb不易下降的一个因素。
Objective To evaluate the effects of selenium （Se） supplementation on concentrations of thyroid peroxidase antibodies （TPOAb） and TPOAb IgG subclasses in autoimmune thyroiditis （AIT） patients with different thyroid functional status. Methods A blind and placebo-controlled prospective study was performed for a total of 134 cases with AIT and thyroid peroxidase antibodies above 300 U/ml. Their mean age was 41 years （range： 15 -70 ）. All of them were recruited from Department of Endocrinology, First Affiliated Hospital of China Medical University from June 2008 to June 2009 and divided into 2 groups according to thyroid function ： euthyroidism or subclinical hypothyroidism （ n = 89） and hypothyroidism （ n = 45 ）. Then they were randomized into 2 groups： selenium-treated and placebo-treated. And 49 cases in subclinical autoimmune thyroiditis group and 28 cases in hypothyroidism group received 200 p,g oral selenium yeast daily for 6 months while others placebo. Serum concentrations of TPOAb, TPOAb IgG subclasses, thyroid-stimulating hormone （TSH） , free thyroxine （FT4 ） and Se were measured at baseline and after 3 and 6 months of follow-up. Results The TPOAb levels showed an overall decrease of 4. 3% at 3 months and of 12. 6% at 6 months （both P 〈 0. 05 ） post-supplementation in subclinical autoimmune thyroiditis patients. In overt hypothyroidism patients, the overall decrease of TPOAb concentrations was 21.9% at 3 months and 20. 4% at 6 months （ both P 〈 0. 05 ） compared with those at pre-treatment. The predominant TPOAb IgG subclasses in sera from the AIT patients were IgG1, IgG3 and IgG4 and the positive percentages 72%, 41% and 72% respectively. The positive rate and concentrations of IgG3 in the patients with hypothyroidism were significantly higher than those of subclinical autoimmune thyroiditis （ P 〈 0. 05 ）. Significant decreases in IgG1 and IgG3 levels were noted in subclinical autoimmune thyroiditis group at 6 months postsupplementation （P 〈 0. 05
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第32期2256-2260,共5页
National Medical Journal of China
基金
国家高技术研究发展计划（863计划）（2007AA022421）
