McDermott E M, Powell R J
Clinical Immunology Unit, University Hospital, Nottingham, United Kingdom.
Ann Rheum Dis. 1996 Apr;55(4):224-9. doi: 10.1136/ard.55.4.224.
To investigate the incidence of ovarian failure after pulse cyclophosphamide treatment in systemic lupus erythematosus (SLE) and to compare this with two control groups: SLE patients treated with azathioprine, and a healthy age matched population.
All women patients with SLE treated with pulse cyclophosphamide in our department were identified and questioned concerning menstrual history. All the hospital notes were reviewed and details recorded on dose of cyclophosphamide, duration of treatment, side effects and lowest pretreatment neutrophil and leucocyte counts during the course of treatment. Disease controls were recruited from our department and healthy controls from the local family health services authority (FHSA) register.
Incidence of ovarian failure in the premenopausal cyclophosphamide treated group was 54% and the incidence of premature menopause (occurring before age 40 years) was 41%. Increasing age at start of treatment showed a linear trend with incidence of ovarian failure (p = 0.01). Using logistic regression, increasing duration of treatment was related to incidence of ovarian failure (p = 0.047 in those treated age 35 years or younger). An association between the lowest neutrophil count throughout the treatment period, when taken immediately before each planned cyclophosphamide pulse, and the incidence of ovarian failure was also demonstrated (p = 0.04 in those treated before age 40 years).
Ovarian failure--in particular, premature failure after treatment with pulse cyclophosphamide--is common. Factors associated with increased risk include greater age at start of treatment, longer period of treatment, and greater degree of marrow suppression as assessed by the neutrophil count immediately before each planned cyclophosphamide pulse.
研究系统性红斑狼疮（SLE）患者接受脉冲环磷酰胺治疗后卵巢功能衰竭的发生率，并与两个对照组进行比较：接受硫唑嘌呤治疗的SLE患者以及年龄匹配的健康人群。
确定我科所有接受脉冲环磷酰胺治疗的SLE女性患者，并询问其月经史。查阅所有病历，记录环磷酰胺剂量、治疗持续时间、副作用以及治疗过程中预处理前最低中性粒细胞和白细胞计数的详细信息。疾病对照组从我科招募，健康对照组从当地家庭健康服务管理局（FHSA）登记册中选取。
绝经前接受环磷酰胺治疗组的卵巢功能衰竭发生率为54%，过早绝经（发生在40岁之前）发生率为41%。开始治疗时年龄增加与卵巢功能衰竭发生率呈线性趋势（p = 0.01）。采用逻辑回归分析，治疗持续时间增加与卵巢功能衰竭发生率相关（35岁及以下接受治疗者p = 0.047）。还证实了在每次计划的环磷酰胺脉冲前立即测定的整个治疗期间最低中性粒细胞计数与卵巢功能衰竭发生率之间存在关联（40岁之前接受治疗者p = 0.04）。
卵巢功能衰竭——尤其是脉冲环磷酰胺治疗后的过早衰竭——很常见。与风险增加相关的因素包括开始治疗时年龄较大、治疗时间较长以及每次计划的环磷酰胺脉冲前通过中性粒细胞计数评估的骨髓抑制程度较高。
