Mok C C, Lau C S, Wong R W
Queen Mary Hospital, Pokfulam, Hong Kong, China.
Arthritis Rheum. 1998 May;41(5):831-7. doi: 10.1002/1529-0131(199805)41:5<831::AID-ART9>3.0.CO;2-1.
To determine the incidence of ovarian failure after cyclophosphamide (CYC) treatment for systemic lupus erythematosus (SLE) and to identify the risk factors for this complication.
The records of 70 premenopausal female SLE patients treated with CYC were reviewed retrospectively. Information on demographic features, autoantibody profiles, and CYC treatment was obtained, and comparisons were made between those who developed ovarian failure and those who did not. Data on the CYC-treated patients were also compared with data on 2 control groups of non-CYC-treated SLE patients.
Eighteen patients developed ovarian failure after CYC treatment, for an overall incidence of 26%. The incidence of ovarian failure showed a linear trend of increase with increasing age at the start of CYC (P = 0.007). The cumulative CYC dose was significantly higher in the patients with ovarian failure than in those without (28.3 gm versus 15.4 gm; P = 0.004). The risk of ovarian failure also showed a linear trend of increase with increasing cumulative CYC dose (P < 0.001). Using multiple logistic regression, the age at the time of CYC treatment initiation (beta = 0.37, SE = 0.11, P = 0.001) and the cumulative dose of CYC received (beta = 0.69, SE = 0.29, P = 0.02) were found to be independent risk factors for CYC-induced ovarian failure.
In our population of female SLE patients, CYC-induced ovarian toxicity is a significant problem, particularly in patients above the age of 40. The age at the start of CYC therapy and the cumulative dose are the major determinants for the development of this complication. For older patients with SLE in whom the use of CYC is warranted, a shorter course and lower dosage should be considered.
确定环磷酰胺（CYC）治疗系统性红斑狼疮（SLE）后卵巢功能衰竭的发生率，并识别该并发症的危险因素。
回顾性分析70例接受CYC治疗的绝经前女性SLE患者的记录。获取人口统计学特征、自身抗体谱和CYC治疗的信息，并对发生卵巢功能衰竭的患者和未发生卵巢功能衰竭的患者进行比较。还将接受CYC治疗患者的数据与2个未接受CYC治疗的SLE患者对照组的数据进行比较。
18例患者在CYC治疗后发生卵巢功能衰竭，总发生率为26%。卵巢功能衰竭的发生率随CYC开始治疗时年龄的增加呈线性上升趋势（P = 0.007）。发生卵巢功能衰竭的患者累积CYC剂量显著高于未发生者（28.3克对15.4克；P = 0.004）。卵巢功能衰竭的风险也随累积CYC剂量的增加呈线性上升趋势（P < 0.001）。采用多因素逻辑回归分析，发现CYC治疗开始时的年龄（β = 0.37，标准误 = 0.11，P = 0.001）和接受的CYC累积剂量（β = 0.69，标准误 = 0.29，P = 0.02）是CYC诱导的卵巢功能衰竭的独立危险因素。
在我们的女性SLE患者群体中，CYC诱导的卵巢毒性是一个重要问题，尤其是在40岁以上的患者中。CYC治疗开始时的年龄和累积剂量是该并发症发生的主要决定因素。对于有必要使用CYC的老年SLE患者，应考虑采用较短疗程和较低剂量。
