目的 探討硒酵母聯(lián)合地塞米松治療慢性淋巴細(xì)胞性甲狀腺炎的療效及其對(duì)患者氧化/抗氧化系統(tǒng)及Fas/FasL表達(dá)的影響，為其臨床診治提供參考。方法 選擇黃岡市中心醫(yī)院2018年5月—2020年6月收治的116例慢性淋巴細(xì)胞性甲狀腺炎患者作為研究對(duì)象，按照治療方法將患者分為對(duì)照組和觀察組，各58例。對(duì)照組患者肌內(nèi)注射地塞米松磷酸鈉注射液1 mg/次，2次/周。觀察組在對(duì)照組的基礎(chǔ)上口服硒酵母片，2片/次，2次/d。兩組均進(jìn)行6個(gè)月的治療。觀察兩組患者的臨床療效，比較兩組治療前后甲狀腺功能、T淋巴細(xì)胞、血清甲狀腺過(guò)氧化物酶抗體（TPOAb）、甲狀腺球蛋白抗體（TGAb）、丙二醛（MDA）、谷胱甘肽過(guò)氧化物酶活性（GSH-P_X）水平及Fas和FasL表達(dá)情況。結(jié)果 治療后，觀察組患者總有效率為94.83%，明顯高于對(duì)照組的79.31%（P<0.05）。治療后，兩組血清游離甲狀腺素（FT4）、游離三碘甲腺原氨酸（FT3）均明顯升高，血清高敏促甲狀腺激素（sTSH）明顯降低（P<0.05），且觀察組血清FT4、FT3水平顯著高于對(duì)照組，sTSH明顯低于對(duì)照組（P<0.05）。治療后，兩組患者血清CD3⁺、CD4⁺、CD4⁺/CD8⁺均明顯升高，血清CD8⁺明顯降低（P<0.05）；且觀察組更為顯著（P<0.05）。治療后，兩組患者血清GSH-Px水平明顯升高，TPOAb、TGAb和MDA水平明顯降低（P<0.05）；且觀察組更為顯著（P<0.05）。治療后，兩組患者血清Fas及FasL表達(dá)明顯降低（P<0.05），且觀察組更為顯著（P<0.05）。結(jié)論 硒酵母聯(lián)合地塞米松治療慢性淋巴細(xì)胞性甲狀腺炎患者可以明顯改善患者甲狀腺功能和氧化/抗氧化系統(tǒng)，有效控制細(xì)胞凋亡，增強(qiáng)機(jī)體免疫功能，效果顯著，具有一定的臨床應(yīng)用價(jià)值。

Objective To explore the effects of selenium yeast combined with dexamethasone in treatment of chronic lymphocytic thyroiditison, and its effect on the oxidative antioxidant system and Fas/FasL expression, to provide references for clinical diagnosis and treatment. Methods A total of 116 patients with chronic lymphocytic thyroiditis admitted to Huanggang Central Hospital from May 2018 to June 2020 were selected as the study subjects. According to the treatment methods, the patients were divided into control group and observation group, with 58 cases in each group. Patients in the control group received intramuscular Dexamethasone Sodium Phosphate Injection 1 mg, twice weekly. Patients in the observation group were po administered with Selenious Yeast Tablets on the basis of control group, 2 tablets/time, twice daily. Both groups were treated for 6 months. Clinical efficacy of two groups was observed. Thyroid function, T lymphocytes, serum levels of TPOAb, TGAb, MDA, GSH-Px, and expression of Fas and FasL were compared between two groups before and after treatment. Results After treatment, the total effective rate of observation group was 94.83%, which was significantly higher than 79.31% of control group (P < 0.05). After treatment, serum FT4 and FT3 in two groups were significantly increased, and serum sTSH was significantly decreased (P < 0.05). The levels of serum FT4 and FT3 in observation group were significantly higher than control group, and sTSH was significantly lower than control group (P < 0.05). After treatment, serum FT4 and FT3 in two groups were significantly increased, serum sTSH was significantly decreased (P < 0.05), and serum FT4 and FT3 levels in observation group were significantly higher than control group, and sTSH was significantly lower than control group (P < 0.05). After treatment, serum CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in two groups were significantly increased, and serum CD8⁺ was significantly decreased (P < 0.05). And the observation group was more significant (P < 0.05). After treatment, the serum GSH-Px level in two groups was significantly increased, while the levels of TPOAb, TGAb and MDA were significantly decreased (P < 0.05). And the observation group was more significant (P < 0.05). After treatment, the expressions of serum Fas and FasL in two groups were significantly decreased (P < 0.05), and the observation group was more significant (P < 0.05). Conclusion Selenium yeast combined with dexamethasone in treatment of chronic lymphocytic thyroiditis patients can significantly improve the thyroid function and antioxidant system, effectively control cell apoptosis, enhance the immune function of the body, the effect is significant, has certain clinical application value.

R977.1

湖北省衛(wèi)健委科研項(xiàng)目（WJ2019M124）