补硒可显著提高慢性萎缩性胃炎疗效!

2021-08-02 胃肠病 胃肠病

补硒可显著提高对萎缩性胃炎的疗效,减少胃癌发病率。

慢性萎缩性胃炎(CAG)是常见胃部疾病,呈局限性或广泛性的胃黏膜固有腺萎缩(数量减少,功能减低),常伴有肠上皮化生、炎性反应及不典型增生。该病被认为是胃爱的癌前疾病,每年发生率为0~11%,而不伴幽门螺杆菌感染的发病率低于1%。

根据国内多年随访资料分析,其绝大多数预后良好,但有一定的癌变几率,其中大部分肠型胃癌是由萎缩性胃炎演变而来的;一般认为其癌变率是:

5〜10年癌变率3%〜5%,10年以上 10%,

轻度异型增生10年癌变率2.5%〜11%,

中度异型增生10 年癌变率4%〜35%,

重度异型增生10年癌变率10%〜83%。

但目前为止,对慢性萎缩性胃炎伴不典型增生的治疗,目前仍缺乏有效的药物和手段。

目前, 临床上对 CAG主要采用抗 Hp 治疗和对症治疗, 但并不能明显改善胃黏膜的病理学病变,因此仍缺少有效的治疗手段。硒具有调节免疫、清除氧自由基的作用, 是 CAG 的潜在疗药物,但其治疗疗效尚不完全明晰。

硒是人体必需的微量元素, 是组成谷胱甘肽过氧化物酶的重要成分,是清除人体内氧自由基的重要的酶,对细胞膜和线粒体膜的氧化损伤有保护作用。

研究发现其具有两方面的药理作用:

①硒是胃肠道黏膜中谷胱甘肽过氧化物酶的必需激活剂, 而激活该酶可清除因胃黏膜中黄嘌呤氧化酶活性过高所产生的氧自由基, 防止氧自由基对胃黏膜的损伤 ; 

②硒具有显著的免疫调节作用, 可激活非特异性免疫和特异性免疫, 增强吞噬细胞、 自然杀伤细胞的活性, 同时又可调节辅助性 T 细胞 Th1 与 Th2 间的平衡, 阻止细胞因子过度分泌, 阻止自身抗体的形成。

研究发现,硒元素与胃部病变密切相关,其主要原因是由于硒元素具有强大的抗氧化功能及免疫调节功能。

胃病患者体内硒水平的降低,会造成免疫功能缺失及抗氧化能力的下降,引起胃黏膜屏障不稳定,黄嘌呤氧化酶在应急情况下会持续升高,造成胃黏膜缺血性损伤,氧自由基增多,导致胃炎、胃溃疡等消化系统病变,适当补硒对防止萎缩性胃炎发展成胃癌有很重要的作用。

补硒干预能显著提高慢性萎缩性胃炎治疗的疗效。

根据国内报道,陈君石院士在我国65个县进行多种营养素与癌症死亡率的相关研究显示,血硒与胃癌死亡率负相关,(男性:相关系数r=-0.28,P<0.05;女性:相关系数r=-0.39,P<0.01)。

于树玉在我国八个省24个地区的调查结果显示,人群血硒水平与胃癌调整死亡率呈负相关,(相关系数r=-0.64,P<0.05)。

来自上海的一项研究,调查了浅表性胃炎、萎缩性胃炎、胃不典型增生(胃癌癌前病变)和胃癌的病例,就他们以往膳食史中硒摄入量、头发中的硒含量、血清中的硒含量、胃液中的硒含量,以及亚硝胺的含量进行分析,这四种样本中的平均硒含量,均为浅表性胃炎高于萎缩性胃炎、萎缩性胃炎和胃不典型增生(胃癌癌前病变)高于胃癌(表1),其亚硝胺的含量低于胃癌,显示出胃黏膜的病变越重,血清中的硒浓度越低,胃液中的致癌物亚硝胺的含量越高,即保护因素越低,危险因素越高,越易发生胃癌。

表 1 血清硒、发硒、胃液硒及摄入硒、胃液中亚硝胺水平(平均数)

殷瓅 ,刘霞等纳入了1077 例慢性萎缩性胃炎患者,进行了行 meta 分析, 评价患者的血硒水平和治疗有效率:其中补硒干预组 541 例患者接受抗幽门螺杆菌(Helicobacter pylori, Hp) 治疗联合补硒干预, 对照组 536 例患者仅接受抗 Hp 治疗。

结果 :补硒干预组患者的临床症状(胃痛、 痞满、 纳差和嗳气) 改善率显著高于对照组, 黏膜内镜检查(腺体萎缩、 肠化生和异型增生) 评分改善率也显著高于对照组 , 同时血硒水平更高。 

结论 :补硒干预能显著提高慢性萎缩性胃炎治疗的疗效。

 

 

表2 黏膜内镜检查评分改善率比较

细胞培养研究表明,硒对细胞有抗致突变作用。

据报道,用亚硒酸钠在硒的浓度为5×l0-5摩/升时,对致癌物——N一甲基一N一硝基一N一亚硝基胍(MNNG)致TA100菌株突变的抑制率为66.5%:硒酵母在硒含量为0.16微克/升时,其抑制率为37.9%。

硒还能抑制胃癌细胞的增生。

亚硒酸钠在硒浓度为 10微摩/升时,硒对人体胃癌细胞株SGC-7901 胃癌细胞的增生抑制率为60.1%,表明硒对胃癌细胞有抑制增生的作用。

动物实验也表明硒有抑癌作用。

原上海第二医科大学附属瑞金医院外科宋建明等用大鼠做动物实验,由分析结果来看,硒可使胃癌减少发生,而且病变也缓慢,故以早期胃癌多见,而未见进展期的胃癌,表明硒有良好的阻断发展成胃癌的作用。

 

表 3 硒对大鼠胃腺不典型增生转变为胃癌的阻断作用

硒可降低人群胃癌的发病率和死亡率。

中国医学科学院肿瘤研究所与美国国立癌症研究所,在河南林县对21584 人采用四种营养素方案,进行6年的干预研究。

每日给药,A组:维生素A 5000单位,锌22.5毫克;

B组:维生素B2 3.2毫克,烟酰胺40毫克;

C组:维生素C 120毫克,钼30微克;

D组:β-胡萝卜素15毫克,硒50微克,维生素E30毫克。

6年后的结果表明,以D组最佳,可降低总死亡率9%,降低总癌死亡率13%,降低胃癌死亡率20%,降低非贲门胃癌死亡率24%,降低总癌发病率8%,降低胃癌发病率16%。可见,硒对胃癌的预防有明显效果。

硒对胃癌癌前病变的阻断研究表明,硒对胃癌癌前病变可明显改善。

吃哪些食物可以补充硒?

富硒的食物不多,真是屈指可数。

●动物制品的硒含量(约0.4-1.5μg/g)比植物体高;

●一般植物谷类的硒含量范围可在<0.1μg/g─>0.8μg/g;

●在海洋生物中,硒类的含量也比植物多,但由于鱼类(尤其是体内含汞的鱼类)会形成汞─硒复合体,造成对硒的生物利用性极低,所硒在鱼类的含量多但对于鱼类本身的利用性极低;

●肉类会提供0.1-0.4μg/g;

●乳制品的硒含量则为<0.3μg/g。

芦笋、富硒苹果、芝麻、麦芽含硒最多。

另外,酵母、蛋和海味,猪肝、肾中的含硒量高于肉。糯米、标准面粉、蘑菇和大蒜中的硒含量比较丰富。但不一定适用于胃病患者。大白菜、南瓜、橙子、香蕉等,也含有一定量的硒。

表 4 含硒食物:排名1~20位(单位微克)

表 5 含硒食物:排名21~40位(单位微克)

我们要从食物中摄取人体需要的硒,必须做食物多样化,不挑食、不偏食,还要注意不能加重胃的负担。也可以购买一些硒制剂进行补充。

参考文献

[1]  李琼 , 刘晏 , 吴坚炯 . 慢性萎缩性胃炎的治疗进展 [J]. 中医学报 , 2013, 28(1): 114-116.

[2]  魏玮 , 杨洋 . 慢性萎缩性胃炎诊治现状及中医药治疗优势

[J]. 中医杂志 , 2016, 57(1): 36-40.

[3]  周连鸿 , 吴裕炘 , 施尧 , 等 . 叶酸及硒酵母对慢性胃炎的萎缩、 肠化及非典型增生的疗效观察 [J]. 中华消化杂志 ,1993, 13(4): 217-219.

[4]  何俐 . Cochrane 系统评价软件 RevMan 简介 [J]. 中国循证医学 , 2001, 1(3): 168-169.

[5]  路敏敏 , 金世禄 , 刘宝珍 , 等 . 慢性萎缩性胃炎的诊断进展 [J]. 中华全科医学 , 2015, 13(5): 823-825.

[6]  杜雯文 , 宁宝森 . 慢性萎缩性胃炎的发病机制、 治疗及胃复春片的临床应用 [J]. 社区医学杂志 , 2013, 11(23): 22-23.

[7]  李岩 , 周丹萍 . 慢性萎缩性胃炎与胃癌 [J]. 临床内科杂志 ,2014, 31(2): 83-85.

[8]  于悦 . 补硒防治萎缩性胃炎及预防癌变显疗效 [J]. 中老年保健 , 2008(9): 51.

[9] 殷瓅 ,刘霞,补硒干预对慢性萎缩性胃炎治疗疗效的循证研究.上海医药 2017年 第38卷 第21期 (11月上)

 

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1201323, encodeId=fc51120132310, content=<a href='/topic/show?id=3333e3516ba' target=_blank style='color:#2F92EE;'>#硒#</a>对<a href='/topic/show?id=33af832113d' target=_blank style='color:#2F92EE;'>#胃炎#</a>的作用,不太相信哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73516, encryptionId=3333e3516ba, topicName=硒), TopicDto(id=83211, encryptionId=33af832113d, topicName=胃炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Mar 10 14:39:59 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942319, encodeId=efff19423190a, content=<a href='/topic/show?id=6b418809e8c' target=_blank style='color:#2F92EE;'>#萎缩性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88097, encryptionId=6b418809e8c, topicName=萎缩性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Sat Jun 25 17:07:35 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1695993, encodeId=e4dc169599327, content=<a href='/topic/show?id=03b98809697' target=_blank style='color:#2F92EE;'>#萎缩#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88096, encryptionId=03b98809697, topicName=萎缩)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53fc29868494, createdName=chendoc252, createdTime=Fri Nov 26 08:07:35 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363302, encodeId=bdde1363302c7, content=<a href='/topic/show?id=98bd536e998' target=_blank style='color:#2F92EE;'>#慢性萎缩性胃炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53679, encryptionId=98bd536e998, topicName=慢性萎缩性胃炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Wed Aug 04 08:07:35 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553043, encodeId=dcfd1553043b8, content=<a href='/topic/show?id=66f588098a9' target=_blank style='color:#2F92EE;'>#萎缩性胃炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88098, encryptionId=66f588098a9, topicName=萎缩性胃炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=315114353005, createdName=habb, createdTime=Wed Aug 04 08:07:35 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033068, encodeId=323010330682e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Aug 02 20:07:35 CST 2021, time=2021-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1004726, encodeId=c4c11004e2698, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45fd5469336, createdName=ms5000001861792842, createdTime=Mon Aug 02 19:10:26 CST 2021, time=2021-08-02, status=1, ipAttribution=)]
    2022-03-10 医者仁者

    #硒##胃炎#的作用,不太相信哦

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1201323, encodeId=fc51120132310, content=<a href='/topic/show?id=3333e3516ba' target=_blank style='color:#2F92EE;'>#硒#</a>对<a href='/topic/show?id=33af832113d' target=_blank style='color:#2F92EE;'>#胃炎#</a>的作用,不太相信哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73516, encryptionId=3333e3516ba, topicName=硒), TopicDto(id=83211, encryptionId=33af832113d, topicName=胃炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Mar 10 14:39:59 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1942319, encodeId=efff19423190a, content=<a href='/topic/show?id=6b418809e8c' target=_blank style='color:#2F92EE;'>#萎缩性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88097, encryptionId=6b418809e8c, topicName=萎缩性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Sat Jun 25 17:07:35 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1695993, encodeId=e4dc169599327, content=<a href='/topic/show?id=03b98809697' target=_blank style='color:#2F92EE;'>#萎缩#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88096, encryptionId=03b98809697, topicName=萎缩)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53fc29868494, createdName=chendoc252, createdTime=Fri Nov 26 08:07:35 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363302, encodeId=bdde1363302c7, content=<a href='/topic/show?id=98bd536e998' target=_blank style='color:#2F92EE;'>#慢性萎缩性胃炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53679, encryptionId=98bd536e998, topicName=慢性萎缩性胃炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Wed Aug 04 08:07:35 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553043, encodeId=dcfd1553043b8, content=<a href='/topic/show?id=66f588098a9' target=_blank style='color:#2F92EE;'>#萎缩性胃炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88098, encryptionId=66f588098a9, topicName=萎缩性胃炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=315114353005, createdName=habb, createdTime=Wed Aug 04 08:07:35 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033068, encodeId=323010330682e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Aug 02 20:07:35 CST 2021, time=2021-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1004726, encodeId=c4c11004e2698, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45fd5469336, createdName=ms5000001861792842, createdTime=Mon Aug 02 19:10:26 CST 2021, time=2021-08-02, status=1, ipAttribution=)]
    2021-11-26 chendoc252
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    2021-08-02 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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    2021-08-02 ms5000001861792842

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