硒與甲狀腺疾病課件

硒與甲狀腺疾病2019-10硒與甲狀腺疾病1硒的作用1、抗氧化功能2、保護心血管3、抗輻射損傷能力4、解毒及抗癌5、其他功能（未知）硒的作用1、抗氧化功能2硒在體內(nèi)的存在形式1、低分子量的硒化合物2、硒蛋白的形式：GSH-PxPHG-Px3、硒代半胱氨酸SeC硒在體內(nèi)的存在形式1、低分子量的硒化合物3硒蛋白第一個發(fā)現(xiàn)的硒蛋白：GSH-Px谷胱甘肽過氧化物酶硒是GSH-Px的必需成分補硒可使GSH-Px活性增強GSH-Px分布廣泛，在腎臟中濃度最高GSH-Px可抑制NF-κB的活化硒蛋白第一個發(fā)現(xiàn)的硒蛋白：GSH-Px4硒蛋白第二個發(fā)現(xiàn)的硒蛋白：PHG-Px磷脂過氧化谷胱甘肽過氧化物酶硒是其的必需成分活性部位與GSH-Px相同硒蛋白第二個發(fā)現(xiàn)的硒蛋白：PHG-Px5硒蛋白還有一些硒蛋白雖然全部功能未知，但它們的一些功能已被人們了解，包括細胞內(nèi)信號的氧化還原調(diào)節(jié)、氧化還原穩(wěn)態(tài)和甲狀腺激素代謝。在病理上，硒蛋白表達降低與硒蛋白N（SEPN）相關(guān)肌病與因甲狀腺激素代謝缺陷（由SBP2遺傳缺陷引起的脫碘酶缺乏）引起的先天性肌病直接相關(guān)。硒蛋白還有一些硒蛋白6硒化合物硒代半胱氨酸Sec

Sec與硒蛋白結(jié)合，參與到UGA密碼子的解碼。硒化合物硒代半胱氨酸Sec7硒的攝入硒：Se足量攝入：人每日攝取硒180-280μg有明顯的防癌作用過量：人每日攝取硒≥819μg，敏感的人會出現(xiàn)硒中毒癥狀硒的攝入硒：Se8硒與疾病硒化合物和硒蛋白與很多疾病有關(guān)：大骨節(jié)病克羅恩?。–D）甲狀腺疾病，包括TAO已與預(yù)防某些癌癥、阿爾茨海默病、心血管疾病和壽命密切相關(guān)。

硒與疾病硒化合物和硒蛋白與很多疾病有關(guān)：9硒與甲狀腺疾病1、Seleniumstatusandover-expressionofinterleukin-15inceliacdiseaseandautoimmunethyroiddiseases.2019

甲狀腺對硒缺乏特別敏感，因為含硒蛋白質(zhì)（含硒代半胱氨酸）在甲狀腺激素的生物合成和活動中起著重要的作用

硒與甲狀腺疾病1、Seleniumstatusando10硒與甲狀腺疾病2、SeleniuminHumanHealthandDisease.2019

seleniumintheenvironment,dietaryintakes,metabolismandstatus,functionsinthebody,thyroidhormonemetabolism,antioxidantdefensesystemsandoxidativemetabolism,andtheimmunesystem.

硒與甲狀腺疾病2、SeleniuminHumanHea11硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

Context:Therecentrecognitionthattheessentialtraceelementseleniumisincorporatedasselenocysteineinallthreedeiodinaseshasdecisivelyconfirmedtheclear-cutlinkbetweenseleniumandthyroidfunction.Ithasadditionallybeenestablishedthatthethyroidcontainsmoreseleniumthananyothertissueandthatseleniumdeficiencyaggravatesthemanifestationofendemicmyxedematouscretinismandautoimmunethyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr12硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceAcquisition:

Clinicalreportsaswellasalargenumberofbiochemicalarticleslinkingseleniumtothyroidhavebeenconsidered.Interventional,prospective,randomized,controlledstudies,includinglargeobservationalstudies,supplementingseleniuminautoimmunethyroiddisease,togetherwithreviewarticlespublishedinMedlineandPubmedhaveundergonescrutiny.Themethodologicaldifferencesandvarietyofresultsemergingfromthesetrialshavebeenanalyzed.

硒與甲狀腺疾病3、SeleniumandtheThyr13硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceSynthesis:Evidenceinsupportofseleniumsupplementationinthyroidautoimmunediseaseisevaluated,theresultshereinpresenteddemonstratingthepotentialeffectivenessofseleniuminreducingtheantithyroidperoxidasetiterandimprovingtheechostructureintheultrasoundexamination.However,considerablediscordremainsastowhoshouldcomprisetargetgroupsforseleniumtreatment,whowillmostbenefitfromsuchtreatment,thepreciseimpactofthebasalantithyroidperoxidaselevel,andtheeffectofdiseasedurationonthetreatmentoutcome.Clearly,furtherin-depthstudiesandevaluationarerequiredconcerningthemechanismofactionofseleniumaswellasthechoiceofsupplementsordietaryintake.Conclusions:

Maintenanceof"selenostasis"viaoptimalintakenotonlyaidspreservationofgeneralhealthbutalsocontributessubstantiallytothepreventionofthyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr14硒與甲狀腺疾病4、Ontheimportanceofseleniumandiodinemetabolismforthyroidhormonebiosynthesisandhumanhealth.2019

Thetraceelementsiodineandselenium(Se)areessentialforthyroidglandfunctioningandthyroidhormonebiosynthesisandmetabolism.Whileiodineisneededastheeponymousconstituentofthetwomajorthyroidhormonestriiodo-L-thyronine(T3),andtetraiodo-L-thyronine(T4),Seisessentialforthebiosynthesisandfunctionofasmallnumberofselenocysteine(Sec)-containingselenoproteinsimplicatedinthyroidhormonemetabolismandglandfunction.TheSe-dependentiodothyroninedeiodinasescontrolthyroidhormoneturnover,whilebothintracellularandsecretedSe-dependentglutathioneperoxidasesareimplicatedinglandprotection.Recently,anumberofclinicalsupplementationtrialshaveindicatedpositiveeffectsofincreasingtheSestatusoftheparticipantsinavarietyofpathologies.ThesefindingsenforcethenotionthatmanypeoplemightprofitfromimprovingtheirSestatus,bothasameanstoreducetheindividualhealthriskaswellastobalanceaSedeficiencywhichoftendevelopsduringthecourseofillness.Eventhoughtheunderlyingmechanismsarestilllargelyuncharacterised,theeffectsofSeappeartobeexertedviamultipledifferentmechanismsthatimpactmostpronouncedontheendocrineandtheimmunesystems.硒與甲狀腺疾病4、Ontheimportanceof15硒與甲狀腺相關(guān)性眼病（TAO）1、Graves'ophthalmopathy,20192、Graves'Orbitopathy，2019在GO的中度至重度活動期疾病階段，行抗炎治療（主要是全身性類固醇的應(yīng)用，眼眶照射），而且在威脅視力的嚴重階段行眼眶減壓手術(shù)。在輕度疾病中，對癥處理和硒補充就可以。在疾病的非活動階段，手術(shù)（眼眶減壓，眼外肌手術(shù)，眼瞼手術(shù)）可以改善外觀和功能。吸煙會增加GO的患病率和嚴重性，并降低治療的效果。甲狀腺功能恢復(fù)正?？梢愿纳萍s60％GO患者的癥狀。

硒與甲狀腺相關(guān)性眼?。═AO）1、Graves'ophth16硒與甲狀腺相關(guān)性眼病（TAO）3、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

有輕度Graves眼病（GO）的患者中，硒的補充可以起到改善軟組織癥狀的作用。

硒與甲狀腺相關(guān)性眼?。═AO）3、Doesselenium17硒與甲狀腺相關(guān)性眼?。═AO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

BackgroundOxygenfreeradicalsandcytokinesplayapathogenicroleinGraves'orbitopathy.MethodsWecarriedoutarandomized,double-blind,placebo-controlledtrialtodeterminetheeffectofselenium(anantioxidantagent)orpentoxifylline(anantiinflammatoryagent)in159patientswithmildGraves'orbitopathy.Thepatientsweregivenselenium(100mugtwicedaily),pentoxifylline(600mgtwicedaily),orplacebo(twicedaily)orallyfor6monthsandwerethenfollowedfor6monthsaftertreatmentwaswithdrawn.Primaryoutcomesat6monthswereevaluatedbymeansofanoverallophthalmicassessment,conductedbyanophthalmologistwhowasunawareofthetreatmentassignments,andaGraves'orbitopathy-specificquality-of-lifequestionnaire,completedbythepatient.SecondaryoutcomeswereevaluatedwiththeuseofaClinicalActivityScoreandadiplopiascore.硒與甲狀腺相關(guān)性眼?。═AO）4、Doesselenium18硒與甲狀腺相關(guān)性眼?。═AO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

Results

Atthe6-monthevaluation,treatmentwithselenium,butnotwithpentoxifylline,wasassociatedwithanimprovedqualityoflife(P<0.001)andlesseyeinvolvement(P=0.01)andslowedtheprogressionofGraves'orbitopathy(P=0.01),ascomparedwithplacebo.TheClinicalActivityScoredecreasedinallgroups,butthechangewassignificantlygreaterintheselenium-treatedpatients.Exploratoryevaluation