Mok C C, Wong R W, Lau C S
Queen Mary Hospital, Hong Kong, China.
Arthritis Rheum. 1999 Jun;42(6):1274-80. doi: 10.1002/1529-0131(199906)42:6<1274::AID-ANR26>3.0.CO;2-B.
To study the effects of ovarian failure on disease flares in systemic lupus erythematosus (SLE).
Fifty-four female premenopausal SLE patients who were under the age of 45 years and treated with continuous oral cyclophosphamide (CYC) for no more than 12 months were studied. All patients had been followed up for >5 years following CYC treatment. Demographic characteristics, clinical and serologic profiles, and information concerning disease flares were recorded. Comparison of the number of severe and mild/moderate flares during the first 5 years after CYC treatment was made between patients who developed CYC-induced ovarian failure and those who did not.
Fourteen SLE patients had documented ovarian failure with hypoestrogenemia within 2 years after CYC treatment. Compared with the menstruating group of patients, those who developed ovarian failure were significantly older at the time of CYC therapy (mean 37.9 versus 25.5 years; P < 0.001), but otherwise no significant differences in organ manifestations and autoantibody profiles between the 2 groups were observed. Both the ovarian failure group and menstruating group of patients had similar SLE Disease Activity Index scores at the time of CYC treatment (mean 15.6 versus 17.7; P = 0.16), and had comparable treatment durations (mean 8.2 versus 7.8 months; P = 0.68) and cumulative doses of CYC (mean 20.4 versus 17.9 grams; P = 0.34). Flares of SLE were uncommon during the first year following CYC administration. However, during the 5-year followup period, patients who developed CYC-induced ovarian failure had significantly fewer severe flares (mean 0.014 versus 0.075 flares/patient-year; P = 0.01) and smaller total number of flares (mean 0.128 versus 0.250 flares/patient-year; P = 0.03) when compared with those who were still menstruating.
This study provides an important clinical observation to support the notion that ovarian failure with hypoestrogenemia is protective against lupus flares and emphasizes the importance of estrogen status in the determination of disease activity in SLE.
研究卵巢功能衰竭对系统性红斑狼疮（SLE）疾病发作的影响。
对54名年龄在45岁以下、接受连续口服环磷酰胺（CYC）治疗不超过12个月的绝经前女性SLE患者进行研究。所有患者在CYC治疗后均随访超过5年。记录人口统计学特征、临床和血清学资料以及有关疾病发作的信息。比较发生CYC诱导的卵巢功能衰竭的患者与未发生者在CYC治疗后前5年中重度和轻度/中度发作的次数。
14名SLE患者在CYC治疗后2年内记录有卵巢功能衰竭伴雌激素缺乏。与月经正常的患者组相比，发生卵巢功能衰竭的患者在接受CYC治疗时年龄显著更大（平均37.9岁对25.5岁；P<0.001），但两组在器官表现和自身抗体谱方面未观察到显著差异。卵巢功能衰竭组和月经正常组患者在CYC治疗时的SLE疾病活动指数评分相似（平均15.6对17.7；P = 0.16），治疗持续时间相当（平均8.2个月对7.8个月；P = 0.68），CYC累积剂量也相当（平均20.4克对17.9克；P = 0.34）。CYC给药后的第一年SLE发作不常见。然而，在5年随访期内，与仍有月经的患者相比，发生CYC诱导的卵巢功能衰竭的患者重度发作明显更少（平均0.014次对0.075次/患者年；P = 0.01），发作总数也更少（平均0.128次对0.250次/患者年；P = 0.03）。
本研究提供了一项重要的临床观察结果，支持雌激素缺乏所致卵巢功能衰竭对狼疮发作具有保护作用这一观点，并强调了雌激素状态在确定SLE疾病活动中的重要性。
