Gärtner R, Angstwurm M
Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Med Klin (Munich). 1999 Oct 15;94 Suppl 3:54-7. doi: 10.1007/BF03042193.
Selenium is an essential component of the intracellular antioxidant system as a structural component of the active center of the glutathione peroxidase enzymes. These selenoenzymes play a major role in protecting cells against peroxidation, especially lipid peroxidation and selenium seems to play a direct role in the regulation of inflammatory processes. In conditions of systemic inflammatory response or sepsis, patients are exposed to severe oxidative stress. These patients already have both, a decreased plasma selenium and glutathione peroxidase activity at admission to the ICU as has been shown in several studies. The degree of selenium deficiency is correlated with the severity of disease and the incidence of mortality. The reason for the low plasma selenium levels is unknown. Especially it would be of interest a) if the low plasma selenium is the consequence of the systemic inflammatory response with distribution of selenium in other compartments of the body, b) most important, whether the substitution of selenium might improve the outcome and decrease the mortality rate of these patients. In 2 independently performed intention-to-treat studies including patients with systemic inflammatory response syndrome or sepsis a beneficial effect of selenium supplementation on multiple organ function and outcome could already be demonstrated as well as a tendency of an improved mortality rate. A prospective analytical study clearly could demonstrate the inverse relationship between low plasma selenium and morbidity and mortality of patients with SIRS/sepsis. The results of these studies are so convincing, that we propose a randomized, prospective, double blind multicenter phase-III study including patients with systemic inflammatory response syndrome or sepsis to investigate, whether a high-dose selenium substitution in addition to the recommended treatment strategies for patients with sepsis improves outcome and mortality rate of these patients.
作为谷胱甘肽过氧化物酶活性中心的结构成分，硒是细胞内抗氧化系统的重要组成部分。这些含硒酶在保护细胞免受过氧化作用，尤其是脂质过氧化方面发挥着主要作用，而且硒似乎在炎症过程的调节中也发挥着直接作用。在全身炎症反应或脓毒症的情况下，患者会面临严重的氧化应激。正如多项研究所示，这些患者在入住重症监护病房时血浆硒和谷胱甘肽过氧化物酶活性均降低。硒缺乏的程度与疾病的严重程度和死亡率相关。血浆硒水平低的原因尚不清楚。特别值得关注的是：a）血浆硒水平低是否是全身炎症反应导致硒在身体其他部位分布的结果；b）最重要的是，补充硒是否可能改善这些患者的预后并降低死亡率。在两项独立进行的意向性治疗研究中，纳入了全身炎症反应综合征或脓毒症患者，结果已经证明补充硒对多器官功能和预后有有益作用，并且有死亡率改善的趋势。一项前瞻性分析研究清楚地证明了血浆硒水平低与全身炎症反应综合征/脓毒症患者的发病率和死亡率之间的负相关关系。这些研究结果非常有说服力，以至于我们提议开展一项随机、前瞻性、双盲多中心III期研究，纳入全身炎症反应综合征或脓毒症患者，以调查除了针对脓毒症患者的推荐治疗策略外，高剂量补充硒是否能改善这些患者的预后和死亡率。
