亚硒酸钠治疗对HT患者血清TPO-Ab滴度及氧化应激水平的影响

发布时间：2018-04-01 09:04

  本文选题：桥本甲状腺炎　切入点：硒　出处：《青岛大学》2017年硕士论文

【摘要】：目的探讨亚硒酸钠治疗对桥本甲状腺炎患者血清甲状腺过氧化物酶抗体(TPO-Ab)滴度和氧化应激水平的影响,分析氧化应激水平与甲状腺过氧化物酶抗体变化相关性。方法采用随机、双盲、安慰剂对照研究的方法,研究对象来源余就诊于青大附院内分泌科门诊的桥本甲状腺炎患者,根据纳入条件及排除条件选取79名,随机分为亚硒酸钠组(A组,共44例)和安慰剂对照组(B组,共35例),亚硒酸钠组给予亚硒酸钠1mg(1片)/d,安慰剂对照组给予安慰剂1片/d,甲状腺机能减退者给予左旋甲状腺素补充治疗,根据甲状腺激素水平调整左旋甲状腺素用量,亚临床甲减及甲状腺功能正常者不给予左旋甲状腺素治疗,双盲治疗时间24周。观察治疗前、治疗12周和治疗24周后患者血清TPO-Ab滴度和血清氧化应激水平(丙二醛MDA水平、谷胱甘肽过氧化物酶GPx活力、超氧化物歧化酶SOD水平)的变化。所有参加本试验的受试者均进行性安全性评估。结果(1)血清甲状腺过氧化物酶抗体滴度:亚硒酸钠组治疗12周和24周后TPO-Ab滴度均较治疗前显著降低,变化具有统计学意义(P0.05),安慰剂对照组治疗12周及24周后抗体水平均无显著变化(P0.05)。亚硒酸钠组治疗24周后,按抗体滴度和病程分层分析,按抗体滴度分层为≤200 IU/ml、200-500 IU/ml及≥500 IU/ml亚组,所有亚组抗体滴度下降幅度在20.67%~29.98%之间,抗体滴度下降幅度最大为≤200 IU/ml亚组,降低幅度29.98%;按照病程分为≤1年、1-5年及5年亚组,所有亚组抗体滴度下降幅度在16.08%~26.63%之间,抗体滴度下降幅度最大为≤1年亚组,降低幅度26.63%。(2)氧化应激指标:亚硒酸钠组治疗12周和24周后MDA水平较治疗前降低,变化具有统计学意义(P0.05),治疗24周后GPx和SOD水平较治疗前均有显著升高(P0.05),安慰剂对照组治疗12周和24周后MDA、GPx和SOD水平较治疗前均无明显变化(P0.05)。亚硒酸钠组治疗后氧化应激水平较安慰剂组明显改善(P0.05)。(3)相关性分析:亚硒酸钠组治疗后MDA与TPO-Ab之间存在显著正相关(r=0.515,P=0.000);SOD与TPO-Ab之间存在负相关(r=-0.305,P=0.044),GPx与TPO-Ab之间未见明显相关性。两组均无不良事件发生。结论亚硒酸钠治疗可降低桥本甲状腺炎患者血清TPO-Ab滴度,改善患者氧化应激水平,病程较短和抗体滴度轻度升高的早期桥本甲状腺炎患者效果更明显。亚硒酸钠治疗后,血清TPO-Ab滴度的下降与氧化应激水平显著改善相关。
[Abstract]:Objective to investigate the effects of sodium selenite treatment on serum thyroid peroxidase antibody titer and oxidative stress level in patients with Hashimoto's thyroiditis, and to analyze the correlation between oxidative stress level and thyroid peroxidase antibody. In a double-blind, placebo-controlled study, 79 patients with Hashimoto's thyroiditis were randomly divided into sodium selenite group (group A) and sodium selenite group (group A). Placebo group (n = 44) and placebo control group (n = 35). Sodium selenite group was given sodium selenite 1mg(1 / d, placebo control group received placebo 1 / d, and patients with hypothyroidism were given levothyroxine supplementation. Patients with subclinical hypothyroidism and normal thyroid function were not treated with levothyroxine according to thyroid hormone level. Serum TPO-Ab titers and serum oxidative stress levels (malondialdehyde (MDA) MDA level, glutathione peroxidase (GPx) activity, glutathione peroxidase (Glutathione peroxidase) GPx activity) were measured after 12 and 24 weeks of treatment. Changes of superoxide dismutase (SOD). All participants in this study were evaluated for progressive safety. Results the titer of serum thyroid peroxidase antibody: sodium selenite group after 12 and 24 weeks of treatment TPO-Ab titer. All of them were significantly lower than those before treatment. There was no significant change in antibody level in the placebo control group after 12 weeks and 24 weeks of treatment. After 24 weeks of treatment, the titer of antibody and the course of treatment in sodium selenite group were analyzed according to the titer of antibody and the course of treatment. According to the titer of antibody, the antibody titers were divided into 鈮，

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