Richter J G, Becker A, Specker C, Schneider M
Department of Endocrinology, Diabetes and Rheumatology, Rheumatology Section, University Hospital Düsseldorf, D 40225 Düsseldorf, Germany.
Scand J Rheumatol. 2008 Sep-Oct;37(5):365-9. doi: 10.1080/03009740801998796.
Current developments in the management of Wegener's granulomatosis (WG) focus on adoption of therapeutic strategies to avoid complications of both the disease and its therapy. Systematic analyses with respect to the reproductive system in WG are missing.
Data of a cross-sectional study of sexual hormones in 19 male WG patients were analysed. Disease extension was classified according to the ears, nose, and throat (E), lungs (L), and kidneys (K) classification (ELK classification) and to the disease extent index (DEI). Laboratory investigation included measurement of gonadotrophins, oestradiol, and total serum testosterone. Hypogonadism was defined by an increase in follicle-stimulating hormone (FSH) beyond twice the upper reference range in the presence of low serum testosterone. Thirty-eight age-matched men served as controls.
Hypogonadism was found in 52.6% of the patients but was not detectable in any of the controls (p<0.0001). No significant correlation to any clinical factor of systemic vasculitis, current or past medication was detected. In particular, testosterone or FSH levels were not correlated with current or cumulative use of cyclophosphamide or corticosteroids (p = 0.417, p = 0.293; p = 0.893, p = 0.317).
Data of our study revealed an unexpected high rate of hypogonadism irrespective of cyclophosphamide use, and subclinical involvement of the testes by the vasculitis itself might be an alternative explanation. Screening during the course of the disease is reasonable as hypogonadism might severely affect patients' quality of life. Further prospective studies with respect to gender-specific changes in the reproductive system are warranted.
韦格纳肉芽肿（WG）治疗的当前进展集中于采用治疗策略以避免疾病及其治疗的并发症。目前尚缺乏对WG患者生殖系统的系统分析。
分析了19例男性WG患者性激素横断面研究的数据。根据耳、鼻、喉（E）、肺（L）和肾（K）分类（ELK分类）以及疾病范围指数（DEI）对疾病范围进行分类。实验室检查包括促性腺激素、雌二醇和总血清睾酮的测定。性腺功能减退的定义为在血清睾酮水平低的情况下，促卵泡生成素（FSH）升高超过正常参考范围上限的两倍。38名年龄匹配的男性作为对照。
52.6%的患者存在性腺功能减退，而对照组未检测到（p<0.0001）。未发现与系统性血管炎的任何临床因素、当前或既往用药有显著相关性。特别是，睾酮或FSH水平与环磷酰胺或皮质类固醇的当前或累积使用无关（p = 0.417，p = 0.293；p = 0.893，p = 0.317）。
我们的研究数据显示，无论是否使用环磷酰胺，性腺功能减退的发生率都出乎意料地高，血管炎本身对睾丸的亚临床累及可能是另一种解释。在疾病过程中进行筛查是合理的，因为性腺功能减退可能严重影响患者的生活质量。有必要进一步开展关于生殖系统性别特异性变化的前瞻性研究。
