Objective: Serum anti Müllerian hormone (AMH) was used to evaluate the effect of cyclophosphamide (CTX) on ovarian function in female patients with systemic lupus erythematosus (SLE). Methods: A total of 121 female patients who were 18-50 years old with normal menstruation were selected. Among them, 54 patients were treated with CTX as the study group and the remaining 67 cases as the control group. Before and after treatment for 6 months, the clinical characteristics, menstruation and AMH level of all patients were recorded and detected. At the same time, the method of using CTX and the cumulative measurement are recorded. Results: (1) Before treatment, there was no significant difference in AMH and mean age, duration of disease and SLEDAI score between the CTX treatment group and the control group. The renal injury in the CTX treatment group (44.4%) was higher than that of the control group (34.3%), and the difference was statistically significant (P<0.05). (2) After 6 months of treatment, the AMH of group CTX decreased from (2.39±1.58) μg/L to (1.56±1.42) μg/L, and the difference was statistically significant (P<0.01). But there was no significant change in the control group. In 54 cases of CTX treatment group, 23 cases (42.6%) had different degree of menstrual abnormalities, while 67 cases had only 8 cases (11.9%) in the control group. Moreover, the AMH level of 31 cases with abnormal menstruation was (0.95±0.59) μg/L, which was significantly lower than that of the other 90 normal cases (2.36±1.58) μg/L. (3) In 54 cases of CTX treatment group, the cumulative dose of CTX was less than 3 g in 14 cases, 33 cases of 3-6 g, 7 cases greater than 6 g. AMH was all were lower than those before treatment. But there was a statistical difference between the 3 g group and 3-6 g group before treatment, and there were statistical differences between the groups. Conclusion: CTX can damage ovarian function in women of childbearing age SLE. Low dose intravenous CTX may have less damage. Serum AMH can be used to monitor ovarian function in patients with SLE and to guide individualized treatment.
目的： 探讨血清抗缪勒管激素（AMH）水平评价环磷酰胺对育龄系统性红斑狼疮（SLE）女性患者卵巢功能的影响。 方法： 选取2013至2017年中日友好医院住院及门诊月经正常的SLE女性患者，共121例，年龄18~50岁。121例中使用环磷酰胺者54例为研究组，其余67例接受其他免疫抑制剂治疗者为对照组。记录并检测所有患者治疗6个月前后的临床特点、月经情况及AMH水平等。同时记录环磷酰胺的使用方法、累积剂量。 结果： （1）治疗前：两组研究对象在AMH水平、年龄、病程、系统性红斑狼疮疾病活动指数（SLEDAI）等方面差异均无统计学意义。研究组肾损伤44.4%，对照组34.3%，差异有统计学意义（P<0.05）。（2）治疗6个月后：研究组AMH由（2.39±1.58）μg/L下降至（1.56±1.42）μg/L，差异有统计学意义（P<0.01），而对照组无明显变化。54例研究组中23例（42.6%）出现不同程度的月经异常，而67例对照组中仅8例（11.9%）。且31例月经异常者AMH水平（0.95±0.59）μg/L，显著低于其他90例月经正常者（2.36±1.58）μg/L。（3）研究组中环磷酰胺累积剂量<3 g者14例，3~6 g者33例，>6 g者7例，这3者的AMH水平均较治疗前下降，<3 g组、3~6 g组与治疗前比较差异有统计学意义（P<0.01），组间差异有统计学意义（P<0.01）。 结论： 环磷酰胺可损害育龄SLE女性患者卵巢功能。小剂量静脉使用环磷酰胺可能对卵巢功能损伤较小。血清AMH水平可用于监测SLE患者卵巢功能，指导个体化治疗。.
Keywords: Anti-Mtillerian hormone; Cyclophosphamide; Ovarian function; Systemic lupus erythematosus.