Lee Jae-Gil, Jang Ji-Young, Baik Seung-Min
Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea.
Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea.
Antioxidants (Basel). 2025 Feb 28;14(3):294. doi: 10.3390/antiox14030294.
Selenium plays an indispensable role in antioxidant defense through its incorporation into selenoproteins, including glutathione peroxidase (GPx) and thioredoxin reductase. In the context of trauma and critical illness, systemic inflammation and oxidative stress frequently deplete selenium reserves, compromising the body's antioxidant defenses. This deficiency exacerbates immune dysfunction, elevates the risk of multi-organ dysfunction syndrome, and increases susceptibility to infections and mortality. Observational studies have consistently shown that lower selenium levels correlate with poorer clinical outcomes, such as extended stays in intensive care units and higher mortality rates. Supplementation of selenium has demonstrated promise in restoring GPx activity, reducing oxidative stress markers, and supporting recovery, particularly in patients with pre-existing selenium deficiency. While the impact on mortality remains variable across clinical trials, early and targeted supplementation appears to be beneficial, especially when combined with other micronutrients like vitamins C and E or zinc. These combinations enhance the antioxidant response and tackle the complex oxidative pathways in critically ill and trauma patients. Importantly, the clinical benefits of selenium supplementation appear to be influenced by baseline selenium status, with patients exhibiting severe deficiency deriving the most pronounced improvements in oxidative stress markers, immune function, and recovery. This review highlights the critical importance of addressing selenium deficiency, advocating for personalized therapeutic strategies. However, further large-scale studies are essential to optimize dosing regimens, refine combination therapies, and validate selenium's therapeutic potential in trauma and critical care settings.
硒通过融入硒蛋白（包括谷胱甘肽过氧化物酶（GPx）和硫氧还蛋白还原酶）在抗氧化防御中发挥不可或缺的作用。在创伤和危重病的情况下，全身炎症和氧化应激经常耗尽硒储备，损害身体的抗氧化防御能力。这种缺乏会加剧免疫功能障碍，增加多器官功能障碍综合征的风险，并增加感染易感性和死亡率。观察性研究一致表明，较低的硒水平与较差的临床结果相关，如在重症监护病房停留时间延长和死亡率较高。补充硒已显示出恢复GPx活性、降低氧化应激标志物和支持恢复的前景，特别是在已有硒缺乏的患者中。虽然在临床试验中对死亡率的影响仍然各不相同，但早期和有针对性的补充似乎是有益的，尤其是与维生素C、E或锌等其他微量营养素联合使用时。这些组合增强了抗氧化反应，并应对了重症和创伤患者复杂的氧化途径。重要的是，补充硒的临床益处似乎受到基线硒状态的影响，表现出严重缺乏的患者在氧化应激标志物、免疫功能和恢复方面有最明显的改善。本综述强调了解决硒缺乏问题的至关重要性，倡导个性化治疗策略。然而，进一步的大规模研究对于优化给药方案、完善联合治疗以及验证硒在创伤和重症监护环境中的治疗潜力至关重要。
