目的 探讨硒酵母联合地塞米松治疗慢性淋巴细胞性甲状腺炎的疗效及其对患者氧化/抗氧化系统及Fas/FasL表达的影响，为其临床诊治提供参考。方法 选择黄冈市中心医院2018年5月—2020年6月收治的116例慢性淋巴细胞性甲状腺炎患者作为研究对象，按照治疗方法将患者分为对照组和观察组，各58例。对照组患者肌内注射地塞米松磷酸钠注射液1 mg/次，2次/周。观察组在对照组的基础上口服硒酵母片，2片/次，2次/d。两组均进行6个月的治疗。观察两组患者的临床疗效，比较两组治疗前后甲状腺功能、T淋巴细胞、血清甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、丙二醛（MDA）、谷胱甘肽过氧化物酶活性（GSH-P_X）水平及Fas和FasL表达情况。结果 治疗后，观察组患者总有效率为94.83%，明显高于对照组的79.31%（P<0.05）。治疗后，两组血清游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）均明显升高，血清高敏促甲状腺激素（sTSH）明显降低（P<0.05），且观察组血清FT4、FT3水平显著高于对照组，sTSH明显低于对照组（P<0.05）。治疗后，两组患者血清CD3⁺、CD4⁺、CD4⁺/CD8⁺均明显升高，血清CD8⁺明显降低（P<0.05）；且观察组更为显著（P<0.05）。治疗后，两组患者血清GSH-Px水平明显升高，TPOAb、TGAb和MDA水平明显降低（P<0.05）；且观察组更为显著（P<0.05）。治疗后，两组患者血清Fas及FasL表达明显降低（P<0.05），且观察组更为显著（P<0.05）。结论 硒酵母联合地塞米松治疗慢性淋巴细胞性甲状腺炎患者可以明显改善患者甲状腺功能和氧化/抗氧化系统，有效控制细胞凋亡，增强机体免疫功能，效果显著，具有一定的临床应用价值。

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

湖北省卫健委科研项目（WJ2019M124）