硒补充疗法对甲状腺相关眼病治疗机制的研究进展

摘要

甲状腺相关眼病(TAO)是一种器官特异性自身免疫性疾病,其发病率居眼眶疾病的首位,许多复杂的病理过程参与其中.其典型的病理改变包括:糖胺聚糖和透明质酸沉积导致的眼眶软组织水肿;眼外肌的纤维化;眶周组织的脂肪变性.临床上常有眶周水肿、复视、眼球突出、眼干、眼睑退缩等表现,晚期患者甚至会由于视神经受到压迫而失明.硒与TAO的多个发病环节有关,硒补充治疗对TAO发病的各个环节均有重要影响.硒对TAO的治疗效果已被证实,但硒补充的最优剂量、治疗的持续时间和安全性等方面仍不明确.目前,补充硒对TAO的治疗作用主要包括中和活性氧集团,调节体液免疫,抑制前列腺素和白三烯等炎性细胞因子的生成;抑制细胞的人白细胞抗原系统-Ⅱ类基因DR分子表达;抑制甲状腺刺激素受体的分泌;抑制甲状腺过氧化物酶抗体的分泌等.本文就硒治疗TAO的作用机制进行综述.%Thyroid associated ophthalmopathy (TAO) is an organ-specific autoimmune-inflammatory disorder,ranking top among the orbital diseases with highest incidences.TAO is characterized by a complex pathogenesis,including glycosaminoglycan and hyaluronic acid deposition,fibrosis of extraocular muscle and adipose degeneration of ocular tissue.The physical manifestations of the disease include periorbital edema,double vision,ophthalmoptosis,ocular dryness,eyelid retraction and on occasion vision loss secondary to optic nerve compression.Selenium evolves in the diversified pathogenesis of TAO.Although the therapeutic effects for TAO of selenium have already been proven,some problems appear to be no clear among the clinicians,such as its optimum dose,duration of the treatment,and safety to date,etc.Nowadays,the mechanism of selenium supplementation in TAO treatment includes neutralization of reactive oxygen,inhibition of HLA-DR expression,inhibition of secretion of TSHR-Ab and TPO-Ab.The aim of the review was to summarize the studies of selenium supplementation theray for TAO.