Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
Division of Rheumatology, Fondazione Policlinico Universitario "A. Gemelli"-I.R.C.C.S., Rome, Italy.
Endocrine. 2019 Feb;63(2):369-375. doi: 10.1007/s12020-018-1783-1. Epub 2018 Oct 15.
Systemic lupus erythematosus (SLE) mainly affects childbearing age women and pharmacological treatments may negatively influence the ovarian reserve. Anti-Müllerian hormone (AMH) could be a good biomarker for ovarian reserve.
AMH serum levels were assessed in 86 consecutive SLE female patients with regular menstrual cycle compared with 44 aged matched healthy controls. Clinical and demographic characteristics, disease duration, pattern of organ involvement, and previous and current therapies were recorded.
AMH levels were comparable between patients and controls (4.2 ± 3.1 ng/ml vs. 5.0 ± 3.1 ng/ml, p = 0.21). According to disease severity, AMH levels were lower in SLE patients with major organ involvement than in controls (3.8 ± 2.7 ng/ml vs. 5.0 ± 3.1 ng/ml, p = 0.08); no difference was found between SLE patients with mild organ involvement (4.5 ± 3.4 ng/ml) and controls (p = 0.43). Grouping patients based on the pharmacological treatments, AMH serum levels did not differ among SLE patients treated with antimalarials only (4.7 ± 3.3 ng/ml), conventional disease-modifying antirheumatic drugs (cDMARDs) only (4.8 ± 3.2 ng/ml), cDMARDs and antimalarials (3.9 ± 2.9 ng/ml) or cyclophosphamide (CYC) only (4.9 ± 3.9 ng/ml), compared to controls, but patients sequentially treated with cDMARDs and CYC, had significantly lower AMH serum levels than controls (p = 0.01).
SLE patients showed comparable AMH levels than controls, however, a reduction of the ovarian reserve was associated with sequentially therapy with CYC and cDMARDs and with the disease severity. AMH could be a sensitive and specific biomarker of ovarian reserve in SLE and it could be useful for therapeutic strategy and family planning.
系统性红斑狼疮（SLE）主要影响育龄妇女，药物治疗可能会对卵巢储备产生负面影响。抗苗勒管激素（AMH）可能是卵巢储备的一个很好的生物标志物。
评估了 86 例月经周期正常的连续 SLE 女性患者的 AMH 血清水平，并与 44 名年龄匹配的健康对照者进行了比较。记录了临床和人口统计学特征、疾病持续时间、器官受累模式、以及既往和当前的治疗情况。
患者和对照组的 AMH 水平无差异（4.2±3.1ng/ml 与 5.0±3.1ng/ml，p=0.21）。根据疾病严重程度，有主要器官受累的 SLE 患者的 AMH 水平低于对照组（3.8±2.7ng/ml 与 5.0±3.1ng/ml，p=0.08）；有轻度器官受累的 SLE 患者（4.5±3.4ng/ml）与对照组之间无差异（p=0.43）。根据药物治疗对患者进行分组，仅接受抗疟药治疗（4.7±3.3ng/ml）、仅接受传统疾病修饰抗风湿药物（cDMARDs）治疗（4.8±3.2ng/ml）、cDMARDs 和抗疟药联合治疗（3.9±2.9ng/ml）或仅接受环磷酰胺（CYC）治疗（4.9±3.9ng/ml）的 SLE 患者的 AMH 血清水平与对照组无差异，但 cDMARDs 和 CYC 序贯治疗的患者的 AMH 血清水平明显低于对照组（p=0.01）。
SLE 患者的 AMH 水平与对照组相当，但卵巢储备的减少与 CYC 和 cDMARDs 的序贯治疗以及疾病严重程度有关。AMH 可能是 SLE 患者卵巢储备的敏感和特异的生物标志物，对治疗策略和计划生育可能有用。
