1 安徽医科大学第三附属医院内分泌科，合肥 230061
2 安徽医科大学第三附属医院核医学科，合肥 230061
目的：探讨血清硒水平对甲巯咪唑(methimazole，MMI)治疗的Graves病(Graves’ disease，GD)合并甲状腺功能亢进的短期控制的影响。方法：选择2015年12月至2017年6月期间在我院内分泌科住院部及门诊就诊的初发GD患者99例，根据硒摄入量不同将99例GD患者分为3组，高剂量补硒组34例，补硒剂量200 μg/d，低剂量补硒组34例，补硒剂量100 μg/d，正常对照组(未服用补硒药物)31例，3组患者均给予MMI治疗，比较3组患者治疗前和治疗12周后的甲状腺结节大小、超敏促甲状腺激素(hypersensitive thyroid stimulating hormone，sTSH)，FT3，FT4及甲状腺过氧化物酶抗体(thyroid peroxidase antibody，TPOAb)，甲状腺球蛋白抗体(TGAb)，促甲状腺激素受体抗体(thyroid stimulating hormone receptor antibody，TRAb)，AST，ALT，γ-谷酰胺转肽酶(gamma glutamine transpeptidase，γ-GGT)，碱性磷酸酶(alkaline phosphatase，ALP)水平。结果：正常对照组的总有效率为74.19%，低剂量补硒组的总有效率为91.18%，高剂量补硒组的总有效率为85.29%，低剂量补硒组的总有效率明显高于对照组，而低硒组和高硒组差异不明显；治疗后补硒组的甲状腺结节大小较对照组呈不同程度缩小，差异有统计学意义(均P<0.05)；3组患者抗甲治疗后FT3，FT4水平较治疗前均有不同程度降低，sTSH明显升高(P<0.01)，而补硒组FT3，FT4降低水平较正常对照组更加明显(P<0.01)；3组患者治疗前TPOAb，TGAb，TRAb水平差异无统计学意义(P>0.05)，治疗后TPOAb，TGAb，TRAb水平与治疗前比较有统计学意义(P<0.01)，而补硒组降低更为明显(P<0.01)。补硒对GD甲状腺功能亢进患者肝功能无明显影响。结论：补硒治疗对GD患者甲状腺功能、甲状腺结节及自身抗体水平临床获益，而对患者肝功能无明显影响。
Effects of selenium on short-term control of Graves’ disease combined with hyperthyroidism treated with methimazole
This work was supported by the Anhui Provincial Public Welfare Research Linkage Project (15011d04065) and the Fifth Cycle Focus on Cultivating Specialist Projects in Hefei (2016.12), China.
Objective: To investigate the effect of serum selenium level on short-term control of Graves’ disease (GD) hyperthyroidism treated with methimazole (MMI). Methods: Ninety-nine patients with newly diagnosed GD were enrolled in the Department of Endocrinology from December 2015 to June 2017. Ninety-nine patients with GD were divided into three groups according to different selenium intake. High-dose selenium supplementation 34 cases of selenium dose of 200 μg/d, low dose of selenium group of 34 cases of selenium dose of 100 μg/d, the normal control group (not taking selenium drugs) 31 cases, the three groups were given MMI treatment. Observe 3 groups of patients before treatment and after 12 weeks of treatment of thyroid nodule size and hypersensitive thyroid stimulating hormone (sTSH), FT3, FT4 and thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), thyroid stimulating hormone receptor antibody (TRAb) and AST, ALT, gamma glutamine transpeptidase (γ-GGT), alkaline phosphatase (ALP). Results: The normal control group total effective rate was 74.19%, and the low dose selenium group the total effective rate was 91.18%, moreover, high dose selenium group the total effective rate was 85.29%, besides the low dose selenium group the total effective rate was significantly higher than the control group, and the difference between low selenium group and high selenium group was not obvious; after treatment, the size of thyroid nodules reduced more significantly than the control group, the difference was statistically significant (P<0.05); the control group after treatment of FT3 and FT4 were significantly lower than before treatment (P<0.01), and decrease the level of selenium group is more obvious (P<0.01); TSH increased significantly; three groups of TPOAb, TGAb, TRAb no significant differences were found before treatment (P>0.05), the three groups after treatment, TPOAb, TGAb, TRAb levels were significantly lower treatment (P<0.01), and the selenium group was significantly lower (P<0.01). Selenium supplementation has no influence on liver function of GD hyperthyroidism. Conclusion: Selenium supplementation is beneficial in the treatment of GD patients in terms of thyroid function, thyroid nodules and autoantibody levels, but has no significant effect on liver function.
selenium; Graves’ disease; thyroid function