风湿

环磷酰胺累积小于3克不影响卵巢功能

作者:Tamirou F, et al. 翻译:北医三院李常虹 来源:中国风湿病公众论坛 日期:2017-08-25
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         前沿进展 | 环磷酰胺累积小于3克不影响狼疮患者的卵巢储备功能

关键字:  环磷酰胺 

        目的:欧洲小剂量静脉输注环磷酰胺(累积3克)治疗狼疮方案可降低性腺的毒性。为阐明这一方案对于卵巢储备功能的较小影响的可能性,我们测定了系统性红斑狼疮(SLE)患者血清中抗苗勒管激素(AMH)的水平,同时将欧洲小剂量狼疮治疗方案与大剂量静脉输注环磷酰胺或不用环磷酰胺方案进行比较。

        方法:采用酶联免疫吸附法检测155例绝经前SLE患者血清中AMH的水平,其中30例接受欧洲小剂量治疗方案,24例接受大剂量静脉注射环磷酰胺方案。所有入组患者均未接受口服环磷酰胺治疗。AMH的水平根据未接受环磷酰胺的SLE患者计算得到的斜率进行年龄调整。同时收集人口统计学资料和临床资料。

        结果:接受欧洲小剂量环磷酰胺治疗的SLE患者血清中AMH的水平(1.46ng/mL)与未接受过细胞毒性药物的SLE患者血清AMH水平(1.85ng/mL)相当。与不接受环磷酰胺的患者相比,静脉输注环磷酰胺超过6克的患者血清AMH水平显著降低(P=0.047)。部分接受欧洲小剂量治疗方案的患者,在治疗前后均收集了血清标本并检测了AMH水平,发现治疗前后血清AMH水平变化不大。

        结论:欧洲小剂量环磷酰胺治疗方案不影响SLE患者的卵巢储备功能,因此可用于有生育计划的女性SLE患者。

        附全文:Abstract OBJECTIVE: The Euro-Lupus regimen of low-dose intravenouscyclophosphamide (IV CYC) (cumulative dose of 3 gm) was developed to reducegonadal toxicity. To address the possibility of a marginal effect on theovarian reserve, we measured serum titers of anti-Müllerian hormone (AMH) inpatients with systemic lupus erythematosus (SLE) treated with the Euro-Lupusregimen and compared them with those measured in patients who were treated withhigher doses of IV CYC or were never treated with IV CYC.METHODS: Serum AMH levels weremeasured by enzyme-linked immunosorbent assay in a cohort of 155 premenopausalSLE patients; 30 of these patients had been treated with the Euro-Lupusregimen, and 24 had received higher doses of IV CYC. None had received oralCYC. AMH levels were age-adjusted using a slope computed from levels measuredacross the group of SLE patients who had not been treated with IV CYC. Demographicand clinical data were collected.RESULTS:Serum titers of AMH measured in SLE patients treated with the Euro-LupusIV CYC regimen (median dose 1.46 ng/ml) did not differ from those measured inpatients never treated with the cytotoxic drug (median 1.85 ng/ml). Asexpected, patients given >6 gm of IV CYC had significantly lower serumtiters of AMH (median 0.83 ng/ml) compared with those never treated with IV CYC(P=0.047). Median serum AMH titers did notchange before (1.24 ng/ml) and after (2.50 ng/ml) treatment with the Euro-LupusIV CYC regimen in the subset of patients for whom paired samples could betested (P=0.43).CONCLUSION: The Euro-Lupus regimen of low-dose IV CYC does notimpact the ovarian reserve of SLE patients and can therefore be proposed astreatment in patients seeking to become pregnant.

        引自:Tamirou F,Husson SN,Gruson D,Debiève F,Lauwerys BR,Houssiau FA. BriefReport: The Euro-Lupus Low-Dose Intravenous Cyclophosphamide Regimen Does NotImpact the Ovarian Reserve, as Measured by Serum Levels of Anti-MüllerianHormone.ArthritisRheumatol.2017 Jun;69(6):1267-1271. doi: 10.1002/art.40079. Epub2017 May 3.

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