Cunha Inês, Saavedra Maria João, Pereira da Silva José António, Malcata Armando
Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Acta Reumatol Port. 2008 Jan-Mar;33(1):69-76.
To determine the frequency of ovarian failure in pre-menopausal women after cyclophosphamide (cyc) treatment for systemic lupus erythematosus (SLE); identify risk factors for this complication; estimate the occurrence and viability of pregnancy during and after treatment.
Review of the data of women treated with intravenous cyc in the department of Rheumatology of Hospitais da Universidade de Coimbra, updated by interview. Information on demographic features; gynaecologic and obstetrical history; characteristics of the disease; duration and side effects of treatment were obtained. Ovarian failure was defined as a lack of menses for, at least, four months and the diagnosis was confirmed by hormonal measurements.
Nineteen pre-menopausal women were treated with intravenous cyc in our department. The mean age at the time of cyc initiation was 28.4 years. Lupus nephritis was the most common indication for cyc treatment (89.5%). The mean number of pulses was 9.3 over a period of 16.8 months. The mean cumulative dosage was 6.973 mg. Three patients developed ovarian failure. Those women were older than the others (P=0.0016). One patient became pregnant while on treatment. Two women delivered healthy children after cyc withdrawal.
Ovarian failure developed in 15.8% of our patients. As described in the literature, the age at cyc initiation appears to be a determinant risk factor. Pregnancy may occur during cyc therapy, and thus, an effective contraception is mandatory. After cyc withdrawal, pregnancy is possible with a favourable outcome.
确定环磷酰胺（cyc）治疗系统性红斑狼疮（SLE）后绝经前女性卵巢功能衰竭的发生率；识别该并发症的危险因素；评估治疗期间及治疗后妊娠的发生情况和可行性。
回顾科英布拉大学医院风湿病科接受静脉注射cyc治疗的女性患者数据，并通过访谈进行更新。获取了有关人口统计学特征、妇科和产科病史、疾病特征、治疗持续时间和副作用的信息。卵巢功能衰竭定义为至少四个月无月经，通过激素测量确诊。
我们科室有19名绝经前女性接受了静脉注射cyc治疗。开始使用cyc时的平均年龄为28.4岁。狼疮性肾炎是cyc治疗最常见的适应症（89.5%）。在16.8个月的时间里，平均脉冲次数为9.3次。平均累积剂量为6973毫克。3名患者出现卵巢功能衰竭。这些女性比其他女性年龄更大（P = 0.0016）。1名患者在治疗期间怀孕。2名女性在停用cyc后产下健康婴儿。
我们的患者中有15.8%发生了卵巢功能衰竭。如文献所述，开始使用cyc时的年龄似乎是一个决定性的危险因素。cyc治疗期间可能会怀孕，因此必须采取有效的避孕措施。停用cyc后，怀孕是可能的，且预后良好。
