Shabanova S S, Ananieva L P, Alekberova Z S, Guzov I I
Department of Microcirculation and Inflammation, Institute of Rheumatology, Moscow.
Clin Exp Rheumatol. 2008 May-Jun;26(3):436-41.
Menstrual cycle disturbances frequently occur during the onset or in exacerbation periods of systemic lupus erythematosus (SLE), suggesting a possible relationship. The aim of the study is to assess the ovarian function in SLE patients with active disease before the treatment with high doses of glucocorticoids (GC) and cytotoxic agents.
We evaluated 94 female SLE patients (mean age of 29.2+/-7.0 years). The mean SLEDAI score was 11.4+/-8.1. Seventy-nine patients had a current use of GC with a median dose of 10 mg/day (8-15). The other 15 patients were untreated. After examination and blood sample collection 40% of the patients were treated and high doses of GC (>30 mg/day); 68% from this group of patients were treated GC in combination with cyclophosphamide (CYC). Forty healthy women with the same mean age were evaluated as controls. A careful gynecological history and a gynecological examination were carried out in patients and controls. Hormonal serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol (E2) and progesterone in SLE patients and controls were measured by enzyme-linked immunosorbent assay (ELISA).
Menstrual cycle disorders with oligomenorrhea as dominant aspect were observed in 54% of SLE patients. The hormonal studies showed decreased progesterone level in 52% of patients, reduced E2 concentration in 25% of patients; increased levels of LH, FSH and prolactin were observed with the lower frequency (13%, 9%, 10% respectively). Menstrual cycle disorders and the hormonal unbalance such as decreased progesterone level and hyperprolactinemia were found related significantly to high SLEDAI score (p<0.05, p=0.001, p<0.05). In the group of non-treated SLE patients the menstrual and hormonal disorders were observed in the same spectrum and with the same frequency as in all the examined SLE patients. SLEDAI score was found correlated significantly with the frequency of menstrual cycle disorders in non-treated SLE patients (p<0.05).
The reported study shows the disease activity as a major factor associated with menstrual cycle disorders in SLE patients before treatment with alkylating agents and high doses of GC. Therefore, SLE women might be considered as a risk group for altered ovarian function.
月经周期紊乱在系统性红斑狼疮（SLE）发病或病情加重期间经常出现，提示两者可能存在关联。本研究旨在评估在高剂量糖皮质激素（GC）和细胞毒性药物治疗前，处于疾病活动期的SLE患者的卵巢功能。
我们评估了94名女性SLE患者（平均年龄29.2±7.0岁）。SLE疾病活动指数（SLEDAI）平均评分为11.4±8.1。79名患者目前正在使用GC，中位剂量为10毫克/天（8 - 15毫克）。另外15名患者未接受治疗。在检查和采集血样后，40%的患者接受了高剂量GC（>30毫克/天）治疗；该组患者中有68%接受了GC联合环磷酰胺（CYC）治疗。40名平均年龄相同的健康女性作为对照进行评估。对患者和对照者进行了详细的妇科病史询问和妇科检查。采用酶联免疫吸附测定（ELISA）法测定SLE患者和对照者血清中促卵泡生成素（FSH）、促黄体生成素（LH）、催乳素、雌二醇（E2）和孕酮的激素水平。
54%的SLE患者出现以月经过少为主的月经周期紊乱。激素研究显示，52%的患者孕酮水平降低，25%的患者E2浓度降低；LH、FSH和催乳素水平升高的频率较低（分别为13%、9%、10%）。月经周期紊乱以及孕酮水平降低和高催乳素血症等激素失衡情况与高SLEDAI评分显著相关（p<0.05，p = 0.001，p<0.05）。在未治疗的SLE患者组中，观察到的月经和激素紊乱情况与所有接受检查的SLE患者相同，且频率也相同。在未治疗的SLE患者中，SLEDAI评分与月经周期紊乱的频率显著相关（p<0.05）。
本研究表明，在使用烷化剂和高剂量GC治疗前，疾病活动是SLE患者月经周期紊乱的主要相关因素。因此，SLE女性可能被视为卵巢功能改变的风险人群。
