中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
32期
2256-2260
,共5页
朱琳%白雪%滕卫平%单忠艳%王薇薇%范晨玲%王红%张红梅
硃琳%白雪%滕衛平%單忠豔%王薇薇%範晨玲%王紅%張紅梅
주림%백설%등위평%단충염%왕미미%범신령%왕홍%장홍매
硒%甲状腺炎,自身免疫性%免疫球蛋白G%甲状腺过氧化物酶抗体
硒%甲狀腺炎,自身免疫性%免疫毬蛋白G%甲狀腺過氧化物酶抗體
서%갑상선염,자신면역성%면역구단백G%갑상선과양화물매항체
Selenium%Thyroiditis,autoimmune%Immunoglobulin G%Thyroid peroxidase antibody
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(＞300 U/ml)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 μg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(FT4)、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亚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.
目的 觀察硒對不同甲狀腺功能(簡稱甲功)狀態的自身免疫性甲狀腺炎(AIT)患者甲狀腺過氧化物酶抗體( TPOAb)及其亞型的影響.方法 收集2008年6月-2009年6月中國醫科大學附屬第一醫院內分泌科134例15 ～70歲(平均年齡41歲)TPOAb暘性(＞300 U/ml)的AIT患者,根據甲功狀態分為亞臨床組(89例),臨床甲狀腺功能減退癥(簡稱甲減)組(45例).每組患者隨機分為補硒組和安慰劑組,補硒組(亞臨床組49例,臨床甲減組28例)患者每天服用200 μg硒酵母,安慰劑組(亞臨床組40例,臨床甲減組17例)患者每天服用安慰劑,均服6箇月.分彆于服藥前、服藥3箇月、服藥6箇月測定血清TPOAb、血清促甲狀腺激素(TSH)、遊離甲狀腺素(FT4)、血清硒濃度、TPOAb亞型.結果 亞臨床組AIT患者補硒3、6箇月時TPOAb分彆較服藥前降低瞭4.3％和12.6％(均P＜0.05),臨床甲減組患者分彆較服藥前降低瞭21.9％和20.4％(均P＜0.05).AIT患者TPOAb亞型以IgG1、IgG3和IgG4為主,暘性率分彆是72％、41％和72％.臨床甲減組IgG3暘性率及濃度均明顯高于亞臨床組(均P ＜0.05).補硒後亞臨床組的IgG1和IgG3濃度均明顯下降(均P＜0.05),甲減組IgG1濃度明顯下降(P＜0.05).77例口服硒酵母的AIT患者中,有52例患者補硒6箇月後TPOAb濃度下降,另外25例患者TPOAb濃度未下降或者上升.TPOAb濃度未下降者IgG1亞型的暘性率及濃度均明顯高于TPOAb濃度下降患者(均P＜0.05).結論 硒可有效降低AIT患者的TPOAb水平,TPOAb以IgG1和IgG3亞型下降為主,高濃度的IgG1可能是導緻TPOAb不易下降的一箇因素.
목적 관찰서대불동갑상선공능(간칭갑공)상태적자신면역성갑상선염(AIT)환자갑상선과양화물매항체( TPOAb)급기아형적영향.방법 수집2008년6월-2009년6월중국의과대학부속제일의원내분비과134례15 ～70세(평균년령41세)TPOAb양성(＞300 U/ml)적AIT환자,근거갑공상태분위아림상조(89례),림상갑상선공능감퇴증(간칭갑감)조(45례).매조환자수궤분위보서조화안위제조,보서조(아림상조49례,림상갑감조28례)환자매천복용200 μg서효모,안위제조(아림상조40례,림상갑감조17례)환자매천복용안위제,균복6개월.분별우복약전、복약3개월、복약6개월측정혈청TPOAb、혈청촉갑상선격소(TSH)、유리갑상선소(FT4)、혈청서농도、TPOAb아형.결과 아림상조AIT환자보서3、6개월시TPOAb분별교복약전강저료4.3％화12.6％(균P＜0.05),림상갑감조환자분별교복약전강저료21.9％화20.4％(균P＜0.05).AIT환자TPOAb아형이IgG1、IgG3화IgG4위주,양성솔분별시72％、41％화72％.림상갑감조IgG3양성솔급농도균명현고우아림상조(균P ＜0.05).보서후아림상조적IgG1화IgG3농도균명현하강(균P＜0.05),갑감조IgG1농도명현하강(P＜0.05).77례구복서효모적AIT환자중,유52례환자보서6개월후TPOAb농도하강,령외25례환자TPOAb농도미하강혹자상승.TPOAb농도미하강자IgG1아형적양성솔급농도균명현고우TPOAb농도하강환자(균P＜0.05).결론 서가유효강저AIT환자적TPOAb수평,TPOAb이IgG1화IgG3아형하강위주,고농도적IgG1가능시도치TPOAb불역하강적일개인소.
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 μg 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 ). IgG1 levels in overt hypothyroidism decreased significantly compared with those at pre-supplementation ( P ＜ 0.05 ).In all patients with supplementation (n =77),the TPOAb levels decreased in 52 at 6 months while increase or no change occurred in 25. The positive percentage and concentrations of IgG1 in patients whose TPOAb levels decreased at 6 months post-supplementation were markedly higher than those whose TPOAb levels increased ( P ＜ 0.05 ). Conclusion Se is effective in reducing TPOAb concentrations and the predominant decreasing TPOAb IgG subclasses are IgG1 and IgG3.And a high level of IgG1 subclass may explain the difficult decline of TPOAb.
