本文選題：橋本甲狀腺炎　切入點：硒　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討亞硒酸鈉治療對橋本甲狀腺炎患者血清甲狀腺過氧化物酶抗體(TPO-Ab)滴度和氧化應(yīng)激水平的影響,分析氧化應(yīng)激水平與甲狀腺過氧化物酶抗體變化相關(guān)性。方法采用隨機、雙盲、安慰劑對照研究的方法,研究對象來源余就診于青大附院內(nèi)分泌科門診的橋本甲狀腺炎患者,根據(jù)納入條件及排除條件選取79名,隨機分為亞硒酸鈉組(A組,共44例)和安慰劑對照組(B組,共35例),亞硒酸鈉組給予亞硒酸鈉1mg(1片)/d,安慰劑對照組給予安慰劑1片/d,甲狀腺機能減退者給予左旋甲狀腺素補充治療,根據(jù)甲狀腺激素水平調(diào)整左旋甲狀腺素用量,亞臨床甲減及甲狀腺功能正常者不給予左旋甲狀腺素治療,雙盲治療時間24周。觀察治療前、治療12周和治療24周后患者血清TPO-Ab滴度和血清氧化應(yīng)激水平(丙二醛MDA水平、谷胱甘肽過氧化物酶GPx活力、超氧化物歧化酶SOD水平)的變化。所有參加本試驗的受試者均進行性安全性評估。結(jié)果(1)血清甲狀腺過氧化物酶抗體滴度:亞硒酸鈉組治療12周和24周后TPO-Ab滴度均較治療前顯著降低,變化具有統(tǒng)計學(xué)意義(P0.05),安慰劑對照組治療12周及24周后抗體水平均無顯著變化(P0.05)。亞硒酸鈉組治療24周后,按抗體滴度和病程分層分析,按抗體滴度分層為≤200 IU/ml、200-500 IU/ml及≥500 IU/ml亞組,所有亞組抗體滴度下降幅度在20.67%~29.98%之間,抗體滴度下降幅度最大為≤200 IU/ml亞組,降低幅度29.98%;按照病程分為≤1年、1-5年及5年亞組,所有亞組抗體滴度下降幅度在16.08%~26.63%之間,抗體滴度下降幅度最大為≤1年亞組,降低幅度26.63%。(2)氧化應(yīng)激指標:亞硒酸鈉組治療12周和24周后MDA水平較治療前降低,變化具有統(tǒng)計學(xué)意義(P0.05),治療24周后GPx和SOD水平較治療前均有顯著升高(P0.05),安慰劑對照組治療12周和24周后MDA、GPx和SOD水平較治療前均無明顯變化(P0.05)。亞硒酸鈉組治療后氧化應(yīng)激水平較安慰劑組明顯改善(P0.05)。(3)相關(guān)性分析:亞硒酸鈉組治療后MDA與TPO-Ab之間存在顯著正相關(guān)(r=0.515,P=0.000);SOD與TPO-Ab之間存在負相關(guān)(r=-0.305,P=0.044),GPx與TPO-Ab之間未見明顯相關(guān)性。兩組均無不良事件發(fā)生。結(jié)論亞硒酸鈉治療可降低橋本甲狀腺炎患者血清TPO-Ab滴度,改善患者氧化應(yīng)激水平,病程較短和抗體滴度輕度升高的早期橋本甲狀腺炎患者效果更明顯。亞硒酸鈉治療后,血清TPO-Ab滴度的下降與氧化應(yīng)激水平顯著改善相關(guān)。
[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，

本文編號：1694862