慢性肾衰竭患者血硒与甲状腺激素变化的相关性分析  

Relationship between selenium in whole blood and serum thyroid hormone in patients with chronic renal failure

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师范学院肾脏病研究所,310015 [2]浙江省杭州市第二人民医院放免中心,310015 [3]浙江省杭州市第二人民医院内分泌科,310015

出　　处：《临床内科杂志》2007年第1期35-37,共3页Journal of Clinical Internal Medicine

基　　金：浙江省教育厅高校科研计划项目(20030968)

摘　　要：目的探讨慢性肾衰竭(CRF)患者血硒与甲状腺激素变化的相关性及其临床意义。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40例CRF患者和30名对照组的全血硒、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)、SOD、丙二醛(MDA)和NO含量进行测定。结果CRF患者全血硒含量、血清TT3、FT3、TT4、FT4、SOD和GSH-px明显低于对照组(P<0.01或<0.05);PTH和MDA明显高于对照组(P<0.01);透析组SOD和GSH-px明显低于非透析组(P<0.01),MDA与非透析组比较无差异。CRF患者血硒与TT3、FT3、SOD和GSH-px呈显著正相关,而与PTH和MDA呈显著负相关;血清TT3与MDA呈显著负相关,而与SOD呈显著正相关;血清FT4与GSH-px呈显著负相关。结论低硒可能通过降低含硒酶-Ⅰ型脱碘酶(ID-Ⅰ)的生物活性,引起血清PTH增高,削弱机体的抗氧化能力等环节导致T向T的转化受阻,使T生成减少,从而影响CRF患者的甲状腺功能。Objective To investigate the relation of selenium in whole blood with serum thyroid hoemone in chronic renal failure （CRF） patients and its clinical significance. Methods Selenium in whole blcod,serum TT3,TT4 ,FT3, FT4 ,super-thyrotropin（s-TSH） ,intact parathyroid hormone （ iPTH ）, malondialdehyde（MDA） and NO concentrations and glutathione perodase （GSH-px） and SOD activities were measured in 40 patients with CRF and 30 normal controls. The relationship among the parameters mentioned above and the selenium in whole blood was analyzed by multiple logistic regression analysis. Resuits The selenium concentration in whole blood of CRF patients was significantly lower as compared with normal control group（ P 〈 0.01 ） ;CRF patients had significantly lower serum TT3,TT4 ,FT3 and FT4 were significantly lower in CRF patients than these in normal controls（ P 〈 0.01 ） ;Serum iPTH concentration in patients with CRF was much higher than that of normal controls（P 〈 0.01 ） ;GSH-px and SOD activities was significantly lower in CRF patients than those in normal controls （P 〈 0. 01 and P 〈 0.05 respectively） and the MDA concentration was significantly higher than that in normal controls （P 〈 0.01 ） ; SOD and GSH-px activities in HD patients were much lower than these of non-dialysis uremic patients（P 〈 0.01 ） and MDA concentration between HD patients and non-dialysis uremic patients was not different; Multiple logistic regression analysis showed that concentration of selenium in whole blood of patients with CRF was positively related to serum TT3 and FT3 concentrations, SOD and GSH-px activities were negatively correlated with iPTH and MDA. Serum TT3 contents were negatively correlated significantly with MDA and positively related to SOD. Serum FT4 concentrationhave negative correlation to GSH-px. Conclusions microelement selenium deficiency may inhibit the process of transforming T4 into T3 through reducing type Ⅰ iodothyronine 5＇-deiodinase（ Ⅰ D-1） activity,inc

关 键 词：血硒 甲状腺激素 甲状旁腺激素 脂质过氧化 慢性肾衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]