Lehmann C, Weber M, Krausch D, Wauer H, Newie T, Rohr U, Hensel M, Glatzel E, Priem F, Grune T, Kox W J
Klinik für Anaesthesiologie und Intensivtherapie, Berlin.
Z Ernahrungswiss. 1998;37 Suppl 1:106-9.
Decreased plasma selenium (Se) levels are common in critically ill patients. Oxidative stress is regarded as one possible cause of the Se deficiency. We investigated in 20 critically ill patients with decreased plasma selenium concentrations the antioxidant metabolism during parenteral selenium supplementation (week 1: 2 x 500 micrograms; week 2:1 x 500 micrograms, week 3:3 x 100 micrograms sodium selenite). As marker of oxidative stress we measured the plasma malondialdehyde levels on days 0, 1, 3, 7, 14, and 21. The content of reduced and oxidized glutathione as well as the leucocyte activity marker elastase were estimated on the same days. Initial plasma Se levels were considerably decreased (0.44 +/- 0.1 mumol/l, mean +/- SEM). After one day of supplementation Se concentrations were in the reference range. Plasma malondialdehyde levels and the ratio of oxidized and reduced glutathione were initially elevated and decreased beginning on day 3 of supplementation. The mean elastase level was 113 +/- 10 micrograms/l on day 0. On day 3 elastase values decreased significantly (85 +/- 13 micrograms/l, p < 0.05; day 21, 19 +/- 7 micrograms/l, p < 0.001). Antioxidant metabolism showed significant changes beginning after 72 hours of therapy. This latency may be explained with the induction of the enzyme glutathione peroxidase. The lowered plasma Se concentrations measured in the critically ill patients and the significant effects on antioxidant metabolism during supplementation emphasized the importance of selenium administration in these patients.
血浆硒（Se）水平降低在重症患者中很常见。氧化应激被认为是硒缺乏的一个可能原因。我们对20名血浆硒浓度降低的重症患者进行了研究，观察胃肠外补充硒期间（第1周：2×500微克；第2周：1×500微克；第3周：3×100微克亚硒酸钠）的抗氧化代谢情况。作为氧化应激的标志物，我们在第0、1、3、7、14和21天测量了血浆丙二醛水平。在同一天评估了还原型和氧化型谷胱甘肽的含量以及白细胞活性标志物弹性蛋白酶。初始血浆硒水平显著降低（0.44±0.1微摩尔/升，均值±标准误）。补充硒一天后，硒浓度处于参考范围内。血浆丙二醛水平以及氧化型和还原型谷胱甘肽的比例最初升高，在补充硒的第3天开始下降。第0天弹性蛋白酶平均水平为113±10微克/升。第3天弹性蛋白酶值显著下降（85±13微克/升，p<0.05；第21天，19±7微克/升，p<0.001）。抗氧化代谢在治疗72小时后开始出现显著变化。这种延迟可能是由于谷胱甘肽过氧化物酶的诱导。重症患者中测得的血浆硒浓度降低以及补充硒期间对抗氧化代谢的显著影响强调了在这些患者中补充硒的重要性。
