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硒元素是人体的必需微量元素之一,参与体内的多种代谢过程。目前认为硒元素主要通过谷胱甘肽过氧化物酶和硫氧还蛋白还原酶发挥抗氧化损伤作用,具有潜在的心血管益处[1-3]。虽然在前瞻观察性研究中发现硒元素能够略微降低心血管疾病的发病风险,但在随机对照试验中尚未观察到这一现象[4-5]。目前主要推测硒元素能够通过抗氧化损伤和调节血脂水平发挥保护心血管的作用[6],其中血脂异常是动脉粥样硬化性心血管疾病的主要危险因素之一[7],然而关于硒元素与血脂关联的研究结果尚存在较大差异,导致关于硒元素潜在的心血管益处尚存争议。
一篇系统综述发现补充硒元素制剂能够降低总胆固醇和甘油三酯,但多项横断面研究却发现血清硒与总胆固醇和甘油三酯的含量正相关,且这种关联可能仅在女性中存在[6, 8-10]。一项前瞻性队列研究发现硒含量与血脂浓度变化负相关,由于该队列人群的硒含量远低于多项发现正相关的研究人群的硒含量,该研究在讨论部分推测硒元素和血脂可能是非线性关系,硒含量过低或过高均能对血脂造成不良影响,这可能是不同研究结果差异较大的原因之一[11-12]。以往研究较少探讨二者可能的非线性关系,也较少聚焦于单一性别人群。定组研究能通过重复测量,在小样本量的情况下获取足够的数据进行数据分析,并能通过自身对照显著降低混杂因素对结果的影响,在环境流行病研究中得到了广泛应用[13]。因此本研究拟通过定组研究设计,探讨育龄妇女人群中血清硒与血脂的线性与非线性关系,为今后育龄妇女人群血清硒元素浓度与血脂关系的探讨提供更多的证据支持。
育龄妇女血清硒元素对血脂的短期影响
The short-term effects of serum selenium on lipids in women of childbearing age
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摘要: 血清硒元素与血脂的关系尚存在争议,两者之间可能存在非线性关联,目前仍缺乏相关可靠证据。本文采用定组研究设计,募集35名育龄妇女进行5次调查,每次均采集并分析血清硒元素和血脂浓度,以探讨育龄妇女体内血清硒元素对血脂的短期影响。分析表明,除甘油三酯外,血清硒元素与总胆固醇 (P = 0.005)、高密度脂蛋白胆固醇 (P<0.001)、低密度脂蛋白胆固醇 (P<0.001)、非高密度脂蛋白胆固醇 (P = 0.01)和脂蛋白(a) (P = 0.03)之间关联的非线性检验均具有统计学意义。仅硒元素浓度在80—130 ng·mL−1时,硒与总胆固醇呈线性关系;仅硒元素浓度在80—140 ng·mL−1时,硒与高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇呈线性关系。整体而言,血清硒元素与血脂浓度之间是非线性关联,在一定浓度范围内,硒浓度升高短期内可能会使血脂浓度升高。Abstract: The associations between serum selenium and blood lipids are still controversial, and there may exist nonlinear relationships between them. However, there is a lack of relevant reliable evidence until now. A panel study design was adopted in this study. A total of 35 women of childbearing age were recruited and visited for 5 times. The concentrations of serum selenium and serum lipids were measured during each visit to explore the short-term effects of serum selenium on lipids. Statistically significant nonlinear relationships were found between serum selenium and total cholesterol (P=0.005), high-density lipoprotein cholesterol (P<0.001), low-density lipoprotein cholesterol (P<0.001), non-high-density lipoprotein cholesterol (P=0.01) and lipoprotein(a) (P=0.03), respectively, while not for triglyceride. Only when serum selenium was within 80 — 130 ng·mL−1, it was linearly associated with total cholesterol. Only when serum selenium was within 80 — 140 ng·mL−1, it was linearly associated with high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. In conclusion, there were non-linear relationships between serum selenium and serum lipids in women of childbearing age. Within a certain range of serum selenium concentration, the blood lipid concentrations increase with serum selenium increasing in a short period.
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Key words:
- selenium /
- lipid metabolism /
- women of childbearing age /
- serum /
- non-linear association
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表 1 河北35名育龄妇女的基本特征
Table 1. Characteristics of the 35 women of childbearing age in Hebei Province
基本特征 Characteristics 人数(构成比/%)N 年龄/均数(标准差) 34.7 (6.5) BMI 正常 (18.5 ≤ BMI < 24) 18 (51) 超重 (24 ≤ BMI < 28) 17 (49) 居住地 农村 17 (49) 乡镇 18 (51) 民族 汉 35 (100) 职业 农民 5 (14) 工人 8 (23) 技术人员 16 (46) 商业和服务业 5 (14) 其他 1 (3) 受教育程度 小学及以下 1 (3) 初中 7 (20) 高中及中专 18 (51) 大专及以上 9 (26) 血脂 M (P25,P75) TC/(mmol·L−1) 4.4(3.7, 5.1) TG /(mmol·L−1) 1.0 (0.7, 1.3) HDL-C/(mmol·L−1) 1.2 (1.0, 1.3) LDL-C /(mmol·L−1) 2.1 (1.7, 2.6) non-HDL-C/(mmol·L−1) 3.2 (2.7,3.9) LP(a)/(mg·L−1) 98.3 (61.9,211.8) 表 2 血清硒元素浓度与血脂的线性关联
Table 2. Linear association between the concentrations of Se and lipids in serum
血脂
Lipids模型
Modelβ P PC% (95%CI) TC 未调整 0.0064 0.002 15.84 (5.67,26.99) 调整后 * 0.0051 0.02 4.50 (0.84, 8.31) TG 未调整 0.0015 0.59 3.52 (-8.67,17.34) 调整后 0.0013 0.65 2.97 (-9.29, 16.89) HDL-C 未调整 0.0029 <0.001 6.86 (3.44,10.39) 调整后 0.0028 <0.001 6.77 (3.39, 10.26) LDL-C 未调整 0.0034 <0.001 8.00 (3.54,12.65) 调整后 0.0032 <0.001 7.66 (3.13, 12.38) non-HDL-C 未调整 0.0020 0.02 4.66 (0.70, 8.78) 调整后 0.0018 0.04 4.16 (0.17,8.31) Lp(a) 未调整 0.0027 0.06 6.33 (-0.32,13.42) 调整后 0.0026 0.07 6.20 (-0.40, 13.24) * 调整了年龄、BMI、受教育程度、职业和居住地。
* adjusted with age, BMI, education level, occupation and location. -
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