血清硒水平与Graves病复发的关系及机制探讨

目的 观察Graves病不同阶段患者血清中硒水平的变化，探讨其在Graves病复发中的作用。方法 收集Graves病患者90例，其中初诊组30例、缓解组30例、复发组30例，健康查体者30例为对照组。应用原子荧光光谱法测定血清硒水平，ELISA法测定血清促甲状激素受体抗体(TRAb)水平，比色法测定血清谷胱甘肽过氧化物酶(GSH-PX)水平，硫代巴比妥酸法测定血清丙二醛(MDA)水平，电化学发光法测定血清游离三碘甲腺原氨酸(FT3)、游离甲状腺激素(FT4)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺球蛋白抗体(TGAb)的水平。结果 血清硒水平初诊组(78.26±19.31)μg/L和复发组(78.86±15.44)μg/L均显著低于对照组(103.01±17.63)μg/L(P<0.01)，缓解组(95.65±15.78)μg/L与对照组相比无显著差异(P>0.05)，复发组与初诊组相比无显著差异(P>0.05)，但较缓解组显著降低(P<0.01)；相关分析显示，各组血清硒与GSH PX呈显著正相关性(P<0.05)，与FT3、FT4、TGAb、TPOAb及MDA无显著相关性(P>0.05)；各组血清硒与TRAb均呈显著负相关性(P<0.05)。结论 血清硒可能通过影响GSH PX活性及TRAb水平参与了Graves病的发生及复发过程。

Relationship between serum selenium level and recurrence of Graves′ disease and its mechanism

Objective To observe the change of serum selenium level in different stages of Graves′ disease and to investigate its role in the recurrence of the disease.Methods 90 cases of Graves′ disease were divided into 3 groups: the newly diagnosed group(n=30),the remission group(n=30) and the recurrence group(n=30).30 normal persons were served as the control group.The serum selenium level was determined by atomic fluorescence spectrometry,the serum TRAb level was determined by ELISA,the serum GSH-Px level was determined by colorimetric method,the serum MDA level was determined by thiobarbituric acid method,and the levels of serum thyroid hormones including FT3 and FT4,TPOAb and TGAb,were determined by electrochemiluminescence.Results The levels of selenium in the new diagnosed group and the recurrence group were(78.26±19.31)μg/L and(78.86±15.44)μg/L respectively,which were significantly lower than that of the control group(103.01±17.63)μg/L(P<0.01).There was no significant difference between the remission group and the control group(P>0.05).The selenium level of the recurrence group had no significant difference compared with that of the new diagnosed group(P>0.05),but was significantly lower than that of the remission group(P<0.01).The correlation analysis showed that the serum selenium level was in positive correlation with the GSH-PX level(P<0.05),but was in no correlation with the levels of FT3、 FT4、 TGAb、 TPOAb and MDA(P>0.05).The level of serum selenium was in negative correlation with the TRAb level in all of the three groups(P<0.05).Conclusion Serum selenium may be involved in the occurrence and recurrence of Graves′ disease by affecting the levels of GSH-PX and TRAb.