Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Department of Obstetrics-Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Clin Rheumatol. 2021 Jun;40(6):2267-2275. doi: 10.1007/s10067-020-05522-5. Epub 2020 Nov 27.
The low prevalence of pregnancy in women with systemic sclerosis (SSc) is due to multi-factorial causes, including premature ovarian insufficiency (POI). The study aimed to determine the prevalence of POI, early menopausal status, and any clinical associations of these among Thai female SSc patients. An analytical cross-sectional study was conducted among female SSc patients between 18 and 45 years of age. The eligible patients underwent blood testing for follicle stimulating hormone and anti-mullerian hormone levels, gynecologic examination, and transvaginal ultrasound for antral follicle count. We excluded patients having surgical amenorrhea, previous radiation, and history of hormonal contraception < 12 weeks and pregnancy. A total of 31 patients were included. The majority (67.7%) had diffuse cutaneous systemic sclerosis. Three patients were POI with a prevalence of 9.7%. The factors associated with POI were a high cumulative dose of cyclophosphamide (CYC) (p = 0.02) and the long duration of CYC used (p = 0.02). After excluding POI, early menopause was detected in 10 patients with a prevalence of 35.7%. The factors associated with early menopause were long disease duration (p = 0.02), high cumulative dose of CYC (p = 0.03), and high cumulative dose of prednisolone (p = 0.02). Low ovarian reserve according to POSEIDON definition was found in 28 patients with the prevalence of 90.3%. POI in Thai SSc was uncommon, whereas early menopause and low ovarian reserve were frequently revealed. A high cumulative dose of CYC was associated with both POI and early menopause. Physicians should be aware of reproductive outcomes and advise patients at risk. Key Points • POI is revealed in patients with SSc particularly in who received high cumulative dose of cyclophosphamide, while early menopause and low ovarian reserve were major reproductive problem among SSc. • Prescriptions for CYC for female SSc-both for young patients of reproductive age and premenopausal middle-aged women-should be concerned of the long-term effects on gonadal function.
在患有系统性硬化症（SSc）的女性中，妊娠的低发生率是多因素造成的，包括卵巢早衰（POI）。本研究旨在确定泰国女性 SSc 患者中 POI 的发生率、早期绝经状态以及这些状态的任何临床关联。
一项横断面分析研究纳入了年龄在 18 至 45 岁之间的女性 SSc 患者。符合条件的患者接受了卵泡刺激素和抗苗勒管激素水平的血液检测、妇科检查和阴道超声的窦卵泡计数。我们排除了手术性闭经、既往放疗以及使用激素避孕药 < 12 周和妊娠的患者。共有 31 名患者入组。大多数（67.7%）患者患有弥漫性皮肤系统性硬化症。3 名患者患有 POI，发生率为 9.7%。与 POI 相关的因素是环磷酰胺（CYC）的累积剂量高（p=0.02）和 CYC 使用时间长（p=0.02）。排除 POI 后，10 名患者（35.7%）出现早期绝经。与早期绝经相关的因素是疾病持续时间长（p=0.02）、CYC 累积剂量高（p=0.03）和泼尼松累积剂量高（p=0.02）。根据 POSEIDON 定义，发现 28 名患者（90.3%）卵巢储备功能低下。泰国 SSc 患者的 POI 并不常见，而早期绝经和卵巢储备功能低下较为常见。高累积剂量的 CYC 与 POI 和早期绝经均相关。医生应注意生殖结局并为有风险的患者提供建议。
POI 在 SSc 患者中较为常见，尤其是接受高累积剂量 CYC 治疗的患者，而早期绝经和卵巢储备功能低下是 SSc 的主要生殖问题。
对于女性 SSc 患者，包括年轻的生育年龄患者和围绝经期的中年女性，处方 CYC 时应考虑到对性腺功能的长期影响。
