中国血液净化

›› 2006, Vol. 5 ›› Issue (3): 128-131.

• 论著 • 上一篇    下一篇

血硒与维持性血液透析患者甲状腺功能的关系

1徐 刚 1林 萍 2蒋挺英 1项 捷 3宁 锂 3张秋玲
  

  1. 310012 杭州，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 2放免中心， 3内分泌科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-03-12 发布日期:2006-03-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-03-12 Published:2006-03-12

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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），MDA与NOHD组比较差异无显著性；⑤直线回归和相关性分析显示：MHD患者血硒与TT 3 (r =0.429,P＜0.01)、FT3(r=0.322, P＜0.05)、 SOD(r=0.498, P＜0.01)和GSH-px（r=0.390,P＜0.01）呈显著正相关,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。

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

Abstract:

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(FT 3) 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 ①The 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 non-dialysis 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 (r =－0.491,P＜0.01) and MDA (r=－0.315, P＜ 0.05). Serum TT3 levels was negatively correlated significantly with MDA(r =－0.365, P＜0.01) and positively or related with SOD(r=0.359, P＜ 0.01) and GSH-px (r=0.296, P ＜0.05). Serum FT3 levels was negatively correlated with MDA(r=-0.302,P＜0.05) and positively related to GSH-px (r=0.306, P＜0.05). Serum FT4 concentration had negatively correlated with GSH-px(r =－0.327, P＜0.01). Conclusion Selenium deficiency may inhibit the course to transform T4 into T3 by reducing typeⅠiodothyronine 5′-deiodinase(ⅠD-Ⅰ) activity,incrasing serum PTH level,enhancing oxidative stress and weakening body’s antioxidative defence and then reduce the concentration of T3 in peripheral tissues.Therefore it is entirely possible that selenium deficiency will effect thyroid function in MHD patients.

Key words: Thyroid hormone, Parathyroid hormone, Lipid peroxides, Hemodialysis

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