Sada Ken-Ei, Miyamae Takako, Kaneko Kayoko, Isojima Sakiko, Ichinose Kunihiro, Matsushita Masakazu, Oku Kenji, Iwata Yasunori, Fujio Keishi, Murashima Atsuko, Tanaka Yoshiya, Nakajima Ayako
Department of Clinical Epidemiology, Kochi Medical School, Nankoku, Japan.
Subcommittee on reproductive issues in rheumatology, Japan College of Rheumatology, Tokyo, Japan.
Mod Rheumatol. 2024 Dec 25;35(1):88-93. doi: 10.1093/mr/roae060.
This systematic scoping review assess the effect of cyclophosphamide (CY) administration during childhood on ovarian function in patients with juvenile-onset connective tissue diseases.
A MEDLINE database search was conducted using terms related to CY, juvenile-onset connective tissue diseases, and ovarian function. Studies were included if they met specific criteria.
The search, conducted on 28 November 2023, yielded 3328 references. After a two-stage screening process, six observational studies on systemic lupus erythematosus patients were included. All studies had a high risk of confounding bias, as none adjusted for confounding variables. Two studies assessing clinical ovarian dysfunction found no clear difference between CY and non-CY groups. However, statistical differences were observed in hormonal profiles. Decreased ovarian reserve was more frequent in CY-exposed patients. Two studies showed significantly higher follicle-stimulating hormone (FSH) levels in the CY group, while one showed a trend towards higher FSH levels without statistical significance.
This review suggested that CY use in childhood may not conclusively have clinically significant effects on ovarian function. Further investigation needed on CY's effect on hormonal levels, fertility, and pregnancy outcomes.
本系统综述评估儿童期使用环磷酰胺（CY）对青少年型结缔组织病患者卵巢功能的影响。
使用与CY、青少年型结缔组织病和卵巢功能相关的术语在MEDLINE数据库中进行检索。符合特定标准的研究纳入其中。
2023年11月28日进行的检索共得到3328篇参考文献。经过两阶段筛选过程，纳入了6项关于系统性红斑狼疮患者的观察性研究。所有研究均存在较高的混杂偏倚风险，因为没有一项研究对混杂变量进行调整。两项评估临床卵巢功能障碍的研究发现CY组和非CY组之间没有明显差异。然而，在激素水平方面观察到了统计学差异。暴露于CY的患者中卵巢储备功能下降更为常见。两项研究显示CY组促卵泡生成素（FSH）水平显著更高，而一项研究显示FSH水平有升高趋势但无统计学意义。
本综述表明儿童期使用CY可能对卵巢功能没有确凿的临床显著影响。需要进一步研究CY对激素水平、生育能力和妊娠结局的影响。
