Berger M M, Reymond M J, Shenkin A, Rey F, Wardle C, Cayeux C, Schindler C, Chioléro R L
Soins Intensifs de Chirurgie, CHUV, Lausanne, Switzerland.
Intensive Care Med. 2001 Jan;27(1):91-100. doi: 10.1007/s001340000757.
To investigate whether early selenium (Se) supplementation can modify the post-traumatic alterations of thyroid hormone metabolism, since the first week after trauma is characterised by low plasma Se and negative Se balances.
Prospective, placebo-controlled randomised supplementation trial.
Surgical ICU in a tertiary university hospital.
Thirty-one critically ill trauma patients aged 42 +/- 16 years (mean +/- SD), with severe multiple injury (Injury Severity Score 30 +/- 7).
Supplementation during the first 5 days after injury with either Se or placebo. The selenium group was further randomised to receive daily 500 microg Se, with or without 150 mg alpha-tocopherol (AT) and 13 mg zinc supplements. The placebo group received the vehicle. Circulating Se, AT, zinc, and thyroid hormones were determined on D0 (= day 0, admission), D1, D2, D5, D10, and D20.
Plasma Se, low on D0, normalised from D1 in the selenium group; total T4 and T3 increased more and faster after D2 (P = 0.04 and 0.08), reverse T3 rising less between D0 and D2 (P = 0.05).
Selenium supplements increased the circulating Se levels. Supplementation was associated with modest changes in thyroid hormones, with an earlier normalisation of T4 and reverse T3 plasma levels. The addition of AT and zinc did not produce any additional change.
鉴于创伤后的第一周以血浆硒水平低和负硒平衡为特征，研究早期补充硒（Se）是否能改变创伤后甲状腺激素代谢的变化。
前瞻性、安慰剂对照随机补充试验。
一所三级大学医院的外科重症监护病房。
31例年龄为42±16岁（均值±标准差）的重症创伤患者，伴有严重多发伤（损伤严重度评分30±7）。
受伤后的前5天补充硒或安慰剂。硒组进一步随机分为每日接受500微克硒，同时给予或不给予150毫克α-生育酚（AT）和13毫克锌补充剂。安慰剂组接受赋形剂。在第0天（=入院当天）、第1天、第2天、第5天、第10天和第20天测定循环中的硒、AT、锌和甲状腺激素。
硒组血浆硒在第0天较低，从第1天开始恢复正常；总T4和T3在第2天后升高得更多、更快（P = 0.04和0.08），反T3在第0天至第2天之间升高较少（P = 0.05）。
补充硒可提高循环中的硒水平。补充硒与甲状腺激素的适度变化有关，T4和反T3血浆水平更早恢复正常。添加AT和锌未产生任何额外变化。
