Association of Nutritional Factors with Thyroid Autoantibody Titer in Hashimoto's Thyroiditis

doi:10.12114/j.issn.1007-9572.2021.01.419

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (17): 2152-2158.DOI: 10.12114/j.issn.1007-9572.2021.01.419

Special Issue: 营养最新文章合辑

• Review • Previous Articles Next Articles

Association of Nutritional Factors with Thyroid Autoantibody Titer in Hashimoto's Thyroiditis

1.The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou 450000, China
2.Endocrinology Ward 2, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
3.Medical College, Hebei University of Engineering, Handan 056000, China
4.The First Affiliated Hospital of Henan University of Chinese Medicine/Institute of Obesity and Metabolic Diseases of Henan University of Chinese Medicine/Henan Workstation, Hubei Chen's Academic School for Gall Disease Studio, National Administration of Traditional Chinese Medicine, Zhengzhou 450000, China
5.Department of International Medicine, Zhengdong Branch, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 410105, China

Received:2021-12-13 Revised:2022-03-06 Published:2022-03-31 Online:2022-03-31
Contact: Shuxun YAN, Ying WANG
About author:
WAN H N, ZHANG G Y, WAN H, et al. Association of nutritional factors with thyroid autoantibody titer in Hashimoto's thyroiditis[J]. Chinese General Practice, 2022, 25 (17) : 2152-2158.

营养因素对桥本甲状腺炎患者甲状腺自身抗体滴度的影响

1.450000　河南省郑州市，河南中医药大学第一临床医学院
2.450000　河南省郑州市，河南中医药大学第一附属医院内分泌科二病区
3.056000　河北省邯郸市，河北工程大学医学院
4.450000　河南省郑州市，河南中医药大学第一附属医院　河南中医药大学肥胖及代谢病研究所　国家中医药管理局湖北陈氏瘿病学术流派传承工作室河南工作站
5.410105　河南省郑州市，郑州大学第一附属医院郑东院区国际医学部

通讯作者: 燕树勋, 王颖
作者简介:
万会娜，张国玉，万红，等.营养因素对桥本甲状腺炎患者甲状腺自身抗体滴度的影响[J].中国全科医学，2022，25（17）：2152-2158.[www.chinagp.net] 作者贡献：万会娜负责文章的设计、构思、撰写论文并对文章负责；张国玉、万红、符宇、王泽瑾负责文章质量控制、审校及文章修订；燕树勋、王颖负责对文章整体负责，监督管理。
基金资助:
河南省科技创新杰出青年支持计划(174100510022); 河南省中医药科学研究专项重点课题(20-21ZY1016)

Abstract

Abstract:

As the most common autoimmune thyroid disease, Hashimoto's thyroiditis (HT) is also the primary cause of hypothyroidism, leading to increased risk of mental diseases, and even myxedema and coma. However, there are few studies on clinical treatments for HT. Thyroid autoantibodies produced in serum due to autoimmune disorders, may be significantly involved in the diagnosis and prognosis of HT. Evidence has suggested that the controlling for the intake of nutrient elements (such as appropriate selenium supplementation and iodine intake) may improve thyroid function by notably reducing the thyroid autoantibody titer, indicating the treatment may be positive in treating HT. But the correlations of various nutritional factors with HT treatment are still controversial. We reviewed recent developments in the treatment of HT, then summarized the influence of controlling for the intake of various nutritional factors (such as selenium, iodine, iron and vitamin D) on the treatment of HT, and concluded that the controlling may help to reduce thyroid autoantibody titers, and improve the therapeutic effect, and may be a reference for clinical treatment of HT.

Key words: Hashimoto disease, Nutrition therapy, Autoantibodies, Root cause analysis, Nutritional factors, Autoantibody titer

摘要：

桥本甲状腺炎（HT）是最常见的自身免疫性甲状腺疾病，也是导致患者甲状腺功能减退（甲减）的最主要因素，甲减会增加患者精神疾病的发病率，甚至会诱发黏液性水肿、昏迷，但有关HT的临床疗法研究目前较少。由于HT患者自身免疫系统紊乱，机体会分泌甲状腺自身抗体，因此甲状腺自身抗体在桥本甲状腺炎的诊断和预后中发挥着重要作用。研究表明，控制营养元素的摄入（如补硒、适碘）对治疗HT具有积极意义，可有效降低甲状腺自身抗体滴度，从而改善患者的甲状腺功能，然而临床对营养因素能否影响HT的治疗尚存争议。本文通过回顾治疗HT的相关研究成果，总结了不同营养因素在HT治疗过程中的作用，发现在治疗HT时，对硒、碘、铁及维生素D等营养因素的调控及干预不仅可发挥降低甲状腺自身抗体滴度的作用，更利于提高治疗HT的效果，能为未来临床治疗HT提供更多参考。

关键词: 桥本病, 营养疗法, 自身抗体, 影响因素分析, 营养因素, 抗体滴度

Huina WAN,Guoyu ZHANG,Hong WAN, et al. Association of Nutritional Factors with Thyroid Autoantibody Titer in Hashimoto's Thyroiditis[J]. Chinese General Practice, 2022, 25(17): 2152-2158. DOI: 10.12114/j.issn.1007-9572.2021.01.419.
万会娜,张国玉,万红等. 营养因素对桥本甲状腺炎患者甲状腺自身抗体滴度的影响[J]. 中国全科医学, 2022, 25(17): 2152-2158. DOI: 10.12114/j.issn.1007-9572.2021.01.419.

Figures/Tables 2

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发表年份	第一作者	研究类型	样本量	研究方案	治疗持续时间	检测指标	主要结果
2015^a	WINTHER^[19]	RCT	124/122/119/126	100 μg富硒酵母vs 200 μg富硒酵母vs 300 μg富硒酵母vs安慰剂	5年	TSH，FT3，FT4	TSH和FT4随硒剂量增加而降低；6个月与5年间无明显差异
2016^a	PIROLA^[10]	RCT	96/96	83 μg SeMet vs无治疗	4个月	TSH，T3，T4，TPOAb	补硒可促进正常甲状腺功能恢复
2016^a	MAO^[18]	RCT	115/114	60 μg硒酵母vs安慰剂	妊娠第12~35周	轻度至中度缺碘孕妇的TPOAb，TgAb，TSH	低剂量补硒对轻中度妊娠期缺碘患者TPOAb无影响，可改善TPOAb阳性患者甲状腺功能
2017^a	ESPOSITO^[16]	RCT	38/38	166 μg SeMet vs安慰剂	6个月	TSH，T3，T4，TPOAb，TgAb	短期补硒在HT中无效
2018^b	WANG^[11]	RCT	181/183	200 μg硒酵母vs安慰剂	6个月	TPOAb，基因分型	补硒后TPOAb滴度明显降低，且受基因分型影响
2019^b	MANTOVANI^[20]	RCT	23/26	83 μg SeMet vs安慰剂	6个月	妊娠期HT患者的TPOAb	补硒后TPOAb滴度明显降低，但对甲状腺激素无影响

发表年份	第一作者	研究类型	样本量	研究方案	治疗持续时间	检测指标	主要结果
2015^a	WINTHER^[19]	RCT	124/122/119/126	100 μg富硒酵母vs 200 μg富硒酵母vs 300 μg富硒酵母vs安慰剂	5年	TSH，FT3，FT4	TSH和FT4随硒剂量增加而降低；6个月与5年间无明显差异
2016^a	PIROLA^[10]	RCT	96/96	83 μg SeMet vs无治疗	4个月	TSH，T3，T4，TPOAb	补硒可促进正常甲状腺功能恢复
2016^a	MAO^[18]	RCT	115/114	60 μg硒酵母vs安慰剂	妊娠第12~35周	轻度至中度缺碘孕妇的TPOAb，TgAb，TSH	低剂量补硒对轻中度妊娠期缺碘患者TPOAb无影响，可改善TPOAb阳性患者甲状腺功能
2017^a	ESPOSITO^[16]	RCT	38/38	166 μg SeMet vs安慰剂	6个月	TSH，T3，T4，TPOAb，TgAb	短期补硒在HT中无效
2018^b	WANG^[11]	RCT	181/183	200 μg硒酵母vs安慰剂	6个月	TPOAb，基因分型	补硒后TPOAb滴度明显降低，且受基因分型影响
2019^b	MANTOVANI^[20]	RCT	23/26	83 μg SeMet vs安慰剂	6个月	妊娠期HT患者的TPOAb	补硒后TPOAb滴度明显降低，但对甲状腺激素无影响

发表年份	第一作者	入组患者	样本量	主要目的	主要结果、结论
2013	BOZKURT^[36]	甲状腺功能正常HT vs新诊断HT vs对照组	180/180/180	评估HT和健康人群的维生素D状态	HT组的维生素D水平明显低于对照组。维生素D缺乏症的严重程度与HT的持续时间，甲状腺体积和抗体滴度相关
2014	SHIN^[37]	AITD vs非AITD	111/193	评估维生素D和抗甲状腺抗体的关系	AITD组TPOAb与维生素D水平呈负相关；维生素D水平是影响AITD患者TPOAb存在的独立因素
2014	UNAL^[38]	HT vs GD vs对照组	254/27/124	研究甲状腺自身抗体与维生素D之间的关系	维生素D水平与甲状腺抗体滴度之间呈负相关
2015	MAZOKOPAKIS^[41]	HT	186	评估补充维生素D₃是否有益于维生素D缺乏症伴HT患者治疗	持续补充维生素D 4个月后，血清抗TPO水平明显降低
2016	MUSCOGIURI^[39]	老年患者	168	研究AITD与老年人低维生素D的关系	维生素D与TPOAb和FT3相关性明显，而与TgAb、TSH和FT4无相关性
2018	夏伟^[40]	HT vs对照组	102/80	评估妊娠期HT患者维生素D水平及影响因素	妊娠期HT患者维生素D水平明显降低，提示维生素D可能参与了妊娠期妇女HT的发病
2019	CHAHARDOLI^[45]	维生素D组vs对照组	21/21	研究维生素D对女性HT患者循环甲状腺自身抗体和T4、T3、TSH的影响	维生素D组抗TgAb和TSH明显降低，抗TPOAb无明显减少，血清T3和T4水平未发生明显变化；补充维生素D有助于减轻HT患者的症状

发表年份	第一作者	入组患者	样本量	主要目的	主要结果、结论
2013	BOZKURT^[36]	甲状腺功能正常HT vs新诊断HT vs对照组	180/180/180	评估HT和健康人群的维生素D状态	HT组的维生素D水平明显低于对照组。维生素D缺乏症的严重程度与HT的持续时间，甲状腺体积和抗体滴度相关
2014	SHIN^[37]	AITD vs非AITD	111/193	评估维生素D和抗甲状腺抗体的关系	AITD组TPOAb与维生素D水平呈负相关；维生素D水平是影响AITD患者TPOAb存在的独立因素
2014	UNAL^[38]	HT vs GD vs对照组	254/27/124	研究甲状腺自身抗体与维生素D之间的关系	维生素D水平与甲状腺抗体滴度之间呈负相关
2015	MAZOKOPAKIS^[41]	HT	186	评估补充维生素D₃是否有益于维生素D缺乏症伴HT患者治疗	持续补充维生素D 4个月后，血清抗TPO水平明显降低
2016	MUSCOGIURI^[39]	老年患者	168	研究AITD与老年人低维生素D的关系	维生素D与TPOAb和FT3相关性明显，而与TgAb、TSH和FT4无相关性
2018	夏伟^[40]	HT vs对照组	102/80	评估妊娠期HT患者维生素D水平及影响因素	妊娠期HT患者维生素D水平明显降低，提示维生素D可能参与了妊娠期妇女HT的发病
2019	CHAHARDOLI^[45]	维生素D组vs对照组	21/21	研究维生素D对女性HT患者循环甲状腺自身抗体和T4、T3、TSH的影响	维生素D组抗TgAb和TSH明显降低，抗TPOAb无明显减少，血清T3和T4水平未发生明显变化；补充维生素D有助于减轻HT患者的症状

Association of Nutritional Factors with Thyroid Autoantibody Titer in Hashimoto's Thyroiditis

营养因素对桥本甲状腺炎患者甲状腺自身抗体滴度的影响

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