抗缪勒管激素评估系统性红斑狼疮患者卵巢储备功能的效果评价

Evaluation of ovarian reserve function in patients with systemic lupus erythematosus by anti-Mueller hormone

目的评价抗缪勒管激素评估系统性红斑狼疮(SLE)患者卵巢储备功能的效果。方法收集枣庄市立医院2015年6月至2018年6月收治的女性SLE患者80例,其中入组前使用环磷酰胺为A组(35例),未使用环磷酰胺为B组(45例),选取同期健康女性志愿者30例为对照组。于月经周期的第3d,采用酶联免疫吸附试验法对各组抗缪勒管激素水平进行检测,采用微粒子酶免疫分析法对各组血清雌激素、卵泡刺激素水平进行检测,同时经阴道超声记录并比较各组双侧卵巢窦卵泡数。结果A组血小板减少、肾炎、溶血性贫血及精神神经表现发生率分别为54.29%(19/35)、85.71%(30/35)、37.14%(13/35)、22.86%(8/35),均明显高于B组的48.89%(22/45)、53.33%(24/45)、13.33%(6/45)、0%(0/45)(χ^2=6.33、9.41、6.16、9.03,均P<0.05)。A组抗缪勒管激素[(1.09±0.33)g/L]和卵巢窦卵泡数[(8±2)个]较B组[(1.98±0.62)g/L、(12±4)个]、对照组[(3.37±1.11)g/L、(15±5)个]均明显降低,三组差异均有统计学意义(F=46.07、25.90,均P<0.01);三组血清雌激素及卵泡刺激素水平差异均无统计学意义(F=1.16、0.97,均P>0.05)。年龄>30岁的SLE患者抗缪勒管激素水平[(0.98±0.31)g/L]较≤30岁者[(1.86±0.60)g/L]明显降低,环磷酰胺累积量>10g的患者抗缪勒管激素水平[(0.36±0.11)g/L]较≤10g[(1.76±0.52)g/L]明显降低(t=7.54、11.30,均P<0.01)。经Pearson相关性分析发现,抗缪勒管激素与SLE患者年龄、环磷酰胺的累积量均呈负相关关系(r=-0.56、-0.45,均P<0.01)。结论抗缪勒管激素对女性SLE患者的卵巢储备功能具有良好的评估价值,抗缪勒管激素水平与患者年龄和环磷酰胺累积量密切相关,临床中对年龄超过30岁、环磷酰胺累积量超过10g者应谨慎使用环磷酰胺。

Objective To evaluate the effect of anti-Mueller hormone on ovarian reserve in female patients with systemic lupus erythematosus(SLE).MethodsThe clinical data of 80 women with SLE in the Department of Rheumatism of Zaozhuang Municipal Hospital from June 2015 to June 2018 were collected.The patients used cyclophosphamide before entering the group were selected as A group(35 cases),and patients who didn't use cyclophosphamide were selected as B group(45 cases),and 30 healthy female volunteers were selected as the control group at the same time.All of them were normal menstrual cycle.At the third day of the menstrual cycle,the levels of anti-Mueller hormones were detected by enzyme linked immunosorbent assay.The serum levels of estrogen and alveolar hormone were detected by microparticle enzyme immunoassay,and the number of ovarian sinus follicles in each group was recorded by transvaginal ultrasound.ResultsThe incidence rate of thrombocytopenia,nephritis,hemolytic anemia and neuropsychiatric manifestations in A group were 54.29%(19/35),85.71%(30/35),37.14%(13/35)and 22.86%(8/35),respectively,which were significantly higher than those in B group[48.89%(22/45),53.33%(24/45),13.33%(6/45),0.00%(0/45)](χ^2=6.33,9.41,6.16,9.03,all P<0.05).The number of anti-Mueller hormone[(1.09±0.33)g/L]and numbers of ovarian sinus follicle[(8±2)]in A group were significantly lower than those in B group[(1.98±0.62)g/L,(12±4)]and control group[(3.37±1.11)g/L,(15±5)],which showed significant differences(F=46.07,25.90,all P<0.05),but there were no statistically significant differences in serum estrogen and follicular stimulating hormone levels among the three groups(F=1.16,0.97,all P>0.05).The level of anti-Mueller hormone in patients with SLE aged>30 years[(0.98±0.31)g/L]was significantly lower than patients≤30 years old[(1.86±0.60)g/L],and the level of anti-Mueller hormone in patients with cyclophosphamide accumulation>10 g[(0.36±0.11)g/L]was significantly lower than that of 10 g[(1.76±0.52)g/L](t=7.54,11.30,both P<0.01).The results of Pearson correlation analysis showed that the anti-Mueller hormone showed negative correlation with the age of SLE and the accumulation of cyclophosphamide(r=-0.56,-0.45,both P<0.01).ConclusionThe use of anti-Mueller hormone has good evaluation value for ovarian reserve function in female patients with SLE,and the level of anti-Mueller hormone is closely related to the age and the accumulation of cyclophosphamide.Therefore,cyclophosphamide should be used carefully in patients who are over 30 years old and the cumulative amount of cyclophosphamide over 10 g.