环磷酰胺对系统性红斑狼疮女性患者卵巢功能损害的研究  

Research of cyclophosphamide in ovarian dysfunction of female patients with systemic lupus erythematosus

作　　者：何春媚[1] 何雪春[1] 廖兢业[1] 林梅[1] 张科[1] 李文根[1] 

机构地区：[1]广东省梅州市人民医院,广东梅州514031

出　　处：《中国医药科学》2015年第9期9-12,48,共5页China Medicine And Pharmacy

基　　金：广东省梅州市科技计划项目(2014B89)

摘　　要：目的：探讨环磷酰胺治疗系统性红斑狼疮的卵巢毒性及其防治对策。方法选取我院2010年1月～2013年12月收治的144例应用环磷酰胺治疗的女性系统性红斑狼疮患者作为观察组，同时选取同时期150例健康女性作为对照组，收集两组实验者的全血标本，检测规范治疗前及治疗后半年、1年系统性红斑狼疮患者的自身抗体、补体、E2、FSH 等血清学指标，并记录治疗前后的月经情况，同时检测健康者的血自身抗体、补体、E2、FSH 等血清学指标，进行对比分析。结果观察组 E2水平治疗后6个月、1年均显著低于治疗前和对照组，FSH 水平治疗后6个月、1年较治疗前和对照组有显著升高，观察组补体 C3、C4水平治疗后6个月、1年均显著高于治疗前（P ＜0.05），对照组同期 C3、C4水平高于观察组（P ＜0.05），观察组患者出现月经异常者122例，约占84.72%，静脉应用后出现月经异常33例（27.05%），口服应用后出现月经异常89例（72.95%），静脉应用和口服应用致月经异常差异具有统计学意义（P ＜0.05），随年龄的增长出现月经异常比例升高，月经异常出现时间越早（P ＜0.05），15～20岁、21～30岁、31～40岁三个年龄段环磷酰胺导致卵巢功能损害的累积剂量中位数分别为31.2g、25.6g、14.3g，经单因素分析：开始使用 CYC 年龄、红斑狼疮活动指数、CYC 累积剂量和 CYC 疗程是发生卵巢毒性的相关因素，而生育状况、其他药物使用与否及肾病综合征未显示与卵巢毒性发生存在联系，经多因素回归分析，在α=0.05的水平，具有统计学意义的影响因素为开始使用 CYC 年龄、CYC 累积剂量和 CYC 疗程。结论环磷酰胺治疗女性系统性红斑狼疮对卵巢功能具有一定的损害作用，胚胎冷冻保存、卵巢移植、促性腺激素释放激素（GnRH）类似物应用及口服避孕药等技术可用于保护卵巢。Objective To investigate ovarian toxicity and countermeasures of cyclophosphamide in patients with systemic lupus erythematosus. Methods 144 female patients with systemic lupus erythematosus treated by cyclophosphamide in our hospital from January 2010 to December 2013 patients were selected as an observation group, while in the same period 150 cases of healthy women were selected as a control group, whole blood samples before and after treatment standardized testing six months, one year in patients with systemic lupus erythematosus autoantibodies, complement, E2, FSH and other serum markers of the two groups were collected and analyzed, and period menstruation was recorded. Results E2 levels for after 6 months, 1 year of the observation group were significantly lower than before treatment and control group, FSH levels after 6 months of treatment, compared with one year before treatment and control group was significantly higher than that in the observation group, complement C3, C4 levels after 6 months of treatment, a significantly higher average annual before treatment （P 〈 0.05）, the control group over the same period C3, C4 levels was higher than that in the observation group （P 〈 0.05）, patients in the observation group were 122 cases of menstrual abnormalities, accounting for 84.72%, menstrual abnormalities 33 cases （27.05%after intravenous application）, menstrual abnormalities 89 cases （72.95%）, after oral application, intravenous and oral applications menstrual abnormalities induced a statistically significant difference （P 〈 0.05）, with age increased the proportion of menstrual abnormalities, menstrual abnormalities appeared time the sooner （P 〈 0.05）, aged 15 to 20, 21 to 30 years old, 31 to 40 years old three age median cumulative dose of cyclophosphamide cause of ovarian dysfunction were 31.2g, 25.6g, 14.3g, univariate analysis： start using CYC age, lupus activity index, CYC cumulative CYC dose and medication related factors of ovarian toxicity, and reproductive stat

关 键 词：系统性红斑狼疮 环磷酰胺 卵巢毒性 防治 

分 类 号：R593.24[医药卫生—内科学]