Gärtner R, Angstwurm M W, Schottdorf J
Klinikum Innenstadt, Universität München.
Med Klin (Munich). 1997 Sep 15;92 Suppl 3:12-4. doi: 10.1007/BF03041951.
It has been hypothesized that low serum selenium concentrations, associated with low glutathione peroxidase activities in critical ill patients may contribute to decreased cleavage from free radicals and deteriorate the clinical outcome.
We therefore performed a controlled, prospective study including 42 patients with inflammatory response syndrome and an APACHE-II score > or = 15. Whereas the controls (Se-, n = 21) received 35 micrograms sodium selenite during the whole treatment period the selenium substitution group (Se+, n = 21) received additional 500 micrograms, 250 micrograms and 125 micrograms sodium selenite, each amount for 3 days. Clinical outcome was monitored by APACHE-III score, documentation of acute renal failure, respiratory insufficiency and the mortality rate until discharge from the hospital.
The mean APACHE-II(III) score on admission was 20.6 (68.3) in the Se- versus 20.1 (61.0) in the Se+ group. Age, sex, underlying diseases, the serum selenium levels and glutathione peroxidase activities on admission were equally distributed in both groups. Selenium substitution was followed by a significant increase in serum selenium levels and glutathione peroxidase activity to normal levels, whereas in controls both parameters remained low. The APACHE-III score significantly improved on day 7 (p = 0.018) and 14 (p = 0.041) in the Se+ group. Hemodialysis because of acute renal failure was necessary in 9 (Se-) versus 3 (Se +) patients (p < 0.04). Overall mortality rate in the Se+ group was 33.5% versus 55% in the Se- group (p = 0.13). A subanalysis of those patients with an APACHE-II score > 20 (n = 10) in each group revealed a significant reduction in mortality from 70% to 30% (p = 0.013). No negative side effects of selenium were seen.
Selenium substitution significantly improves clinical outcome and reduces the incidence of acute renal failure.
据推测，危重症患者血清硒浓度低，与谷胱甘肽过氧化物酶活性低有关，这可能导致自由基清除减少，使临床结局恶化。
因此，我们进行了一项对照前瞻性研究，纳入42例炎症反应综合征患者，急性生理与慢性健康状况评分系统（APACHE）-II评分≥15分。对照组（硒缺乏组，n = 21）在整个治疗期间接受35微克亚硒酸钠，而硒替代组（硒补充组，n = 21）额外接受500微克、250微克和125微克亚硒酸钠，每种剂量各用3天。通过APACHE-III评分、急性肾衰竭记录、呼吸功能不全情况及直至出院的死亡率来监测临床结局。
入院时，硒缺乏组的平均APACHE-II（III）评分为20.6（68.3），硒补充组为20.1（61.0）。两组患者的年龄、性别、基础疾病、入院时血清硒水平和谷胱甘肽过氧化物酶活性分布均衡。硒替代后，血清硒水平和谷胱甘肽过氧化物酶活性显著升高至正常水平，而对照组这两个参数仍较低。硒补充组在第7天（p = 0.018）和第14天（p = 0.041）时APACHE-III评分显著改善。因急性肾衰竭而需要进行血液透析的患者，硒缺乏组有9例，硒补充组有3例（p < 0.04）。硒补充组的总体死亡率为33.5%，硒缺乏组为55%（p = 0.13）。对每组中APACHE-II评分>20分的患者（n = 10）进行亚组分析发现，死亡率从70%显著降低至30%（p = 0.013）。未观察到硒的负面副作用。
硒替代可显著改善临床结局并降低急性肾衰竭的发生率。
