Silva C A A, Hilário M O, Febrônio M V, Oliveira S K, Terreri M T, Sacchetti S B, Sztajnbok F R, Marini R, Quintero M V, Bica B E, Pereira R M, Bonfá E, Ferriani V P, Robazzi T C, Magalhães C S
Pediatric Rheumatology Unit, University of São Paulo, Brazil.
Lupus. 2007;16(7):531-6. doi: 10.1177/0961203307079300.
We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2 +/- 3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04 +/- 2.5 versus 17.8 +/- 3.1 years; P = 0.001), and had a shorter period of time between menarche and current age (3.4 +/- 2.9 versus 6.7 +/- 5.4 years; P = 0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea (P > 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI (P = 0.01) and SLICC/ACR-DI (P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR = 1.059; CI = 1.004-1.116; P = 0.034) and SLICC/ACR-DI (OR = 2.125; IC = 1.373-3.291; P = 0.001) scores. Our data suggest that in spite of immunosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage.
我们评估了在巴西12个儿科风湿病中心随访的298例符合美国风湿病学会（ACR）标准的女性青少年系统性红斑狼疮（JSLE）患者中闭经的患病率及其临床关联。35例患者（11.7%）出现闭经，平均持续时间为7.2±3.6个月。32/35例患者进行了激素检测，根据青春期变化，他们中没有一人的促卵泡生成素（FSH）和促黄体生成素（LH）水平高于正常范围且雌二醇低于正常范围。闭经的JSLE患者年龄更小（15.04±2.5岁 vs 17.8±3.1岁；P = 0.001），月经初潮至当前年龄的时间更短（3.4±2.9年 vs 6.7±5.4年；P = 0.001）。有趣的是，接受静脉注射环磷酰胺治疗的患者与未出现闭经的患者在治疗频率、累积剂量、脉冲次数和治疗持续时间方面相似（P>0.05）。相比之下，与未出现闭经的患者相比，闭经患者的系统性红斑狼疮疾病活动指数（SLEDAI）（P = 0.01）和系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SLICC/ACR-DI）（P = 0.024）得分显著更高。多变量分析确定的独立危险因素是更高的SLEDAI（比值比[OR]=1.059；置信区间[CI]=1.004 - 1.116；P = 0.034）和SLICC/ACR-DI（OR = 2.125；IC = 1.373 - 3.291；P = 0.001）得分。我们的数据表明，尽管进行了免疫抑制治疗，但JSLE患者仍有足够的卵巢卵泡储备，闭经尤其与疾病活动和损伤相关。
