Pediatric Rheumatology Unit and Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
Clin Exp Rheumatol. 2012 May-Jun;30(3):445-9. Epub 2012 Jun 26.
To perform systematic assessment of ovarian reserve markers using a combination of tests in juvenile systemic lupus erythematosus (JSLE) patients without amenorrhoea.
Twenty-seven consecutive JSLE female patients and 13 healthy controls without amenorrhoea were evaluated for 6 months. Ovarian reserve was assessed during early follicular phase by serum levels of follicle stimulating hormone (FSH), luteinising hormone (LH), estradiol, inhibin A, inhibin B and anti-Mullerian hormone (AMH). Ovarian size was measured by abdominal ultrasonography. Demographic data, disease activity, damage and treatment were also analysed.
The median of current age was similar in JSLE patients and controls (16.5 vs. 15years, p=0.31) with a significantly higher age at menarche (13 vs. 12years, p=0.03). A trend of lower median total antral follicle count was observed in JSLE compared to controls (9 vs. 14.5, p=0.062) with similar median of other ovarian reserve parameters (p>0.05). Further evaluation of patients treated with cyclophosphamide and those without this treatment revealed a higher median FSH levels (6.4 vs. 4.6 IU/L, p=0.023). Inhibin B, AMH levels and ovarian volume were also lower but did not reach statistical significance (10.8 vs. 27.6 pg/mL, p=0.175; 0.6 vs. 1.5 ng/mL, p=0.276; 3.4 vs. 5 cm3, p=0.133; respectively). LH (2.7 vs. 2.9 IU/L, p=0.43), estradiol (50 vs. 38 pg/mL, p=0.337) and inhibin A (1.1 vs. 0 pg/mL, p=0.489) levels were comparable in both groups.
Our study suggests that ovarian reserve after cyclophosphamide treatment may be hampered in spite of the presence of menstrual cycles emphasising the relevance of gonadal protection during the use of this alkylating agent.
对无闭经的幼年系统性红斑狼疮（JSLE）患者进行联合检测，以系统评估卵巢储备标志物。
对 27 例连续的 JSLE 女性患者和 13 例无闭经的健康对照者进行了 6 个月的评估。在卵泡早期通过血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇、抑制素 A、抑制素 B 和抗苗勒管激素（AMH）水平评估卵巢储备情况。通过腹部超声测量卵巢大小。还分析了人口统计学数据、疾病活动、损伤和治疗情况。
JSLE 患者和对照组的中位当前年龄相似（16.5 岁比 15 岁，p=0.31），但初潮年龄显著较高（13 岁比 12 岁，p=0.03）。与对照组相比，JSLE 患者的总窦卵泡计数中位数较低（9 比 14.5，p=0.062），但其他卵巢储备参数的中位数相似（p>0.05）。进一步评估接受环磷酰胺治疗的患者和未接受该治疗的患者发现，FSH 水平中位数较高（6.4 比 4.6 IU/L，p=0.023）。抑制素 B、AMH 水平和卵巢体积也较低，但未达到统计学意义（10.8 比 27.6 pg/mL，p=0.175；0.6 比 1.5 ng/mL，p=0.276；3.4 比 5 cm3，p=0.133）。两组的 LH（2.7 比 2.9 IU/L，p=0.43）、雌二醇（50 比 38 pg/mL，p=0.337）和抑制素 A（1.1 比 0 pg/mL，p=0.489）水平相当。
本研究表明，即使存在月经周期，环磷酰胺治疗后的卵巢储备可能也会受到阻碍，这强调了在使用这种烷化剂时保护性腺的重要性。
