血硒与维持性血液透析患者甲状腺功能的关系  

Relationship between selenium in whole blood and thyroid function in maintenance hemodialysis patients

作　　者：徐刚[1] 林萍[1] 蒋挺英[2] 项捷[1] 宁锂[3] 张秋玲[3] 

机构地区：[1]浙江省杭州市第二人民医院肾内科,杭州310012 [2]杭州师范学院肾脏病研究所放免中心 [3]杭州师范学院肾脏病研究所内分泌科

出　　处：《中国血液净化》2006年第3期128-131,共4页Chinese Journal of Blood Purification

基　　金：浙江省教育厅高校科研计划项目(20030968)

摘　　要：目的探讨血硒与维持性血液透析(MHD)患者甲状腺功能的关系及其临床意义。方法运用原子荧光光谱、放射免疫、生化比色和化学发光法分别对浙江省杭州市第二人民医院肾内科杭州师范学院肾脏病研究所20例MHD患者、20例非透析慢性肾衰竭(NOHD)患者和20例正常对照者的全血硒,血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、超敏促甲状腺激素(s-TSH),甲状旁腺激素(PTH),谷胱甘肽过氧化物酶(GSH-px)、超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)含量进行测定,并分析其相关性。结果①MHD患者全血硒含量明显低于对照组(P<0.01),也低于NOHD组,但差异无显著性;②血清TT3、FT3、TT4、FT4明显低于对照组(P<0.01),与NOHD组比较差异无显著性;③PTH明显高于对照组(P<0.01),低于NOHD组,但差异无显著性;④血清SOD、GSH-px明显低于对照组(P<0.01),MDA明显高于对照组(P<0.01);SOD和GSH-px均明显低于NOHD组(P<0.01),M0D.0A1与)、NFOTH3D(组r=0比.3较22差,P异<无0显.0著5)性、;S⑤OD直(r线=回0.归49和8,相P关<性0分.0析1)显和示G:SHM-HpDx患(r者=0血.硒39与0,TPT<3(0r.=010).呈42显9,著P<正相关,而与PTH(r=-0.491,P<0.01)和MDA(r=-0.315,P<0.05)呈显著负相关;血清TT3与MDA呈显著负相关(r=-0.365,P<0.01),而与SOD(r=0.359,P<0.01)和GSH-px(r=0.296,P<0.05)呈显著正相关;FT3与MDA(r=-0.302,P<0.05)呈显著负相关,而与GSH-px(r=0.306,P<0.05)呈显著正相关;FT4与GSH-px(r=-0.327,P<0.01)呈显著负相关。结论缺硒可使Ⅰ型脱碘酶(ID-Ⅰ)生物活性降低、血清PTH浓度增高以及氧化应激增强而阻碍T4向T3转化,使T3生成减少,进而影响MHD患者的甲状腺功能。Objective To investigate the relationship of selenium in whole blood and thyroid function in maintenance hemodialysis（MHD） patients and its clinical significance. Methods Selenium in whole blood, serum total triiodothyronine（TT3）,total thyroxine（TT4）,free- T3（FT3） free-T4 （FT4 ）, sensitive thyroid stimulating hormone （s-TSH）, parathyroid hormone（PTH）, malondialdehyde（MDA） and nitric oxide（NO） concentrations and glutathione perodase（GSH px） and supperoxide dismutase（SOD） activities were measured in 20 MHD patients, 20 non dialysis uremic patients and 20 normal controls（NC）.The relationship between above parameters and the change of selenium in whole blood was analyzed by multiple logistic regression analysis. Results ① The selenium concentration in whole blood of MHD patients was significantly lower than that in NC（P〈0. 01）, and lower than that in non-dialysis uremic patients without statistical sigbificance （P〈0. 05）： ②MHD patients had significantly lower serum TT3,TT4, FT3 and FT4 levels than those in NC（P〈0.01）,but without significant difference of those between MHD patients and nondialysis uremic patients; ③Serum PTH concentration in MHD patients was much higher than that of NC（P〈0.01）, but that between MHD patients and non dialysis uremic patients was not different; ④MHD patients had significant lower serum SOD and GSH-px activities than those in NC（ P〈0.01 ） and their MDA levels was significantly higher（P〈0.01）. SOD and GSH-px activities in MHD patients were much lower than those of non- dialysis uremic patients（P〈0.01） and MDA levels between MHD patients and non-dialysis uremic patients was not different;⑤Multiple logistic regression analysis showed that concentration of selenium in whole blood in MHD patients was positively or related with serum TT3 （ r = 0.429, P〈0.01） and FT3 （r=0. 322, P〈 0.05）,SOD（r =0.498, P〈0.01） and GSH-px（r = 0.390, P〈0.01） and negatively correlated with PTH

关 键 词：血硒 甲状腺激素 甲状旁腺激素 脂质过氧化 血液透析 

分 类 号：R318.16[医药卫生—生物医学工程]