肾虚型系统性红斑狼疮卵巢储备功能下降的研究

Study of Impaired Ovarian Reserve in Systemic Lupus Erythematosus Women with Kidney Deficiency

【目的】探讨系统性红斑狼疮(SLE)女性患者血清抗缪勒氏管激素(AMH)水平与肾虚的相关性。【方法】102例18~45岁的SLE女性患者中,49例为肾虚型,53例为非肾虚型。分析肾虚组与非肾虚组SLE患者的临床症状、疾病活动度(SLEDAI-2K)、自身抗体水平(补体C3和C4、免疫球蛋白IgG和IgM、ds-DNA等)和血清AMH水平的差异,并与50例正常对照组比较。【结果】(1)相较于非肾虚组SLE患者,肾虚组SLE患者病程更长(P<0.01),出现肾炎和血细胞减少频率更高(P<0.01)。而肾虚组与非肾虚组SLE患者SLEDAI-2K评分及补体C3和C4、免疫球蛋白IgG和IgM、ds-DNA等指标比较,差异均无统计学意义(P>0.05)。(2)肾虚组月经减少的情况较非肾虚组更加常见(P<0.01),并且显示与肾虚具有较高的关联强度(OR=13.23,95%CI为5.14~34.19)。(3)经过和未经过环磷酰胺(CYC)治疗的肾虚组SLE女性患者的AMH水平均较正常对照组降低(P<0.01或P<0.05)。另一方面,未经过CYC治疗的肾虚组SLE女性患者比未经过CYC治疗的非肾虚组SLE女性患者AMH水平低(P=0.000)。(4)在未经过CYC治疗的肾虚组SLE女性患者中AMH水平降低的频率大大增加,32例患者中有13例AMH出现减少(占40.6%),而正常对照组50例中仅1例AMH出现减少(占2.0%),差异有统计学意义(χ~2=20.56,P=0.000),并且显示与肾虚具有较高的关联强度(OR=33.5,95%CI为4.10~274.27)。【结论】肾虚与SLE患者肾炎、血细胞减少、月经减少和AMH水平降低有关,提示肾虚可能严重损害育龄期SLE女性患者的卵巢储备功能。

Objective To explore the correlation between kidney deficiency（KD）and serum levels of anti-Müllerian hormone（AMH）in women with systemic lupus erythematosus（SLE）. Methods A total of 102 SLEwomen aged 18-45 years old,of them 49 with the syndrome of KD and 53 with non-kidney deficiency（non-KD）were recruited. Clinical symptoms,the scores of the Systemic Lupus Erythematosus Disease Activity Index 2000（SLEDAI-2 K）,auto-antibodies levels of complement C3 and C4,immunoglobulin G（IgG）,immunoglobulin M（IgM）and ds-DNA, and serum AMH level were observed and compared with those in 50 healthy volunteers（normal control group）. Results（1）The KD SLE group had longer course of disease,and had higher incidence ofnephritis and cytopenia than non-KD SLE group（P 0.01）. There was no significant difference in SLEDAI-2 Kscores or serum levels of ds-DNA,complement C3 and C4,IgG,IgM,ds-DNA between the two groups（P〈0.05）.（2）Hypomenorrhea was more frequently seen in KD SLE group than that in non-KD SLE group（P 0.01）,and hypomenorrhea presented obvious correlation with KD（OR=13.2395%;95% CI being 5.14-34.19）.（3）AMH level in kidney deficiency patients treated with or without cyclophosphamide（CYC）was lower than thatin the normal control group（P〈0.01 or P〈0.05）. And KD SLE patients having no medication of CYC had lowerAMH level than non-KD SLE patients having no medication of CYC（P = 0.000）.（4）In 32 KD SLE patientshaving no medication of CYC,13 cases（accounting for 40.6%）had the decrease of serum AMH level,while onlyone case（accounting for 2.0%）from the 50 healthy volunteers had the decrease of serum AMH level, thedifference being significant（χ2= 20.56,P = 0.000）and the correlation with KD being obvious（OR = 33.5,95%CI being 4.10-274.27）. Conclusion Kidney deficiency has been confirmed to be associated with nephritis,cytopenia, hypomenorrhea and decreased AMH level, which indicates that KD would have strong effect onimpairing the ovarian reserve in SLE women during reproductive age.