Kien C L, Ganther H E
Am J Clin Nutr. 1983 Feb;37(2):319-28. doi: 10.1093/ajcn/37.2.319.
A child receiving total parenteral nutrition for about 1 1/2 yr developed intermittent leg muscle pain and tenderness and elevation in serum activities of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and creatine kinase. Approximately 6 months later he developed white fingernail beds. Detailed cardiological evaluation revealed no evidence of cardiac muscle cell damage despite markedly elevated serum activities of the MB isoenzyme of creatine kinase. Retrospective analyses of serum and 24 hr urine samples collected during this period demonstrated very low serum Se concentration (0.003 to 0.007 micrograms/g) and urine excretion (0.0 to 8.9 micrograms/day) Se. Intravenous Se supplementation (42 micrograms/day elemental Se as H2SeO3) and a prospective study of biochemical Se status were begun 33.5 months after initiation of total parenteral nutrition. Serum Se concentration and whole blood glutathione peroxidase activity and Se concentration were respectively 0.020 mu/g, 3.5 EU/g Hb, and 0.018 microgram/g, 1 month after intravenous Se therapy was started. These very low values increased after further Se therapy. Serum enzyme activities markedly improved and the fingernail bed abnormalities resolved after therapy.
一名接受了约1年半全胃肠外营养的儿童出现间歇性腿部肌肉疼痛和压痛，血清谷氨酸草酰乙酸转氨酶、谷氨酸丙酮酸转氨酶和肌酸激酶活性升高。大约6个月后，他出现了指甲床变白的情况。详细的心脏评估显示，尽管肌酸激酶MB同工酶的血清活性显著升高，但没有心肌细胞损伤的证据。对在此期间采集的血清和24小时尿液样本进行回顾性分析发现，血清硒浓度非常低（0.003至0.007微克/克），尿硒排泄量也很低（0.0至8.9微克/天）。在开始全胃肠外营养33.5个月后，开始静脉补充硒（每天42微克元素硒，以亚硒酸形式）并对硒的生化状态进行前瞻性研究。开始静脉硒治疗1个月后，血清硒浓度、全血谷胱甘肽过氧化物酶活性和硒浓度分别为0.020微克/克、3.5酶活性单位/克血红蛋白和0.018微克/克。经过进一步的硒治疗后，这些极低的值有所上升。治疗后血清酶活性明显改善，指甲床异常情况消失。
