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目的研究抗苗勒管激素(AMH)与系统性红斑狼疮(SLE)女性患者使用免疫抑制剂的关系,评估SLE患者卵巢贮备功能。方法选取2009年1月-2013年12月72例年龄在18~40岁,符合美国风湿病学会诊断标准的初诊SLE女性患者,使用酶联免疫吸附测定法对患者用药前后血清中AMH进行检测,选取同期20例同年龄段健康女性作为正常对照。比较使用环磷酰胺(CTX)患者(A组,n=41)与未使用CTX患者(B组,n=31)血清AMH的差异,了解AMH水平与CTX累积剂量及年龄之间的关系。结果 72例SLE患者使用免疫抑制剂后血清中AMH水平[(2.39±1.12)ng/m L]较使用前[(3.12±1.38)ng/m L]及正常对照组[(2.95±0.86)ng/m L]低,差异均有统计学意义(P<0.05)。治疗后A组患者血清中AMH水平[(2.24±1.23)ng/m L]低于治疗前[(2.97±1.31)ng/m L],且低于B组患者血清中AMH水平[(2.92±0.82)ng/m L],差异有统计学意义(P<0.05);B组治疗前差异无统计学意义(P>0.05)。AMH水平与使用CTX累积剂量及年龄呈负相关(P<0.05)。结论 AMH可以作为评价SLE女性患者在使用CTX后造成卵巢损伤的一个指标。
Objective To investigate the relationship between anti-Mullerian hormone (AMH) and immunosuppressants in female patients with systemic lupus erythematosus (SLE) and to evaluate the ovarian reserve in SLE patients. Methods From January 2009 to December 2013, 72 newly diagnosed SLE women aged 18-40 years who met the diagnostic criteria of the American College of Rheumatology were enrolled in this study. Serum AMH levels were measured by enzyme-linked immunosorbent assay (ELISA) Select the same period 20 cases of healthy women of the same age as a normal control. To compare AMH levels in patients with CTX (group A, n = 41) with those without CTX (group B, n = 31) to determine the relationship between AMH levels and CTX cumulative dose and age. Results The serum level of AMH in 72 SLE patients after immunosuppressive therapy was significantly higher than that before use [(3.12 ± 1.38) ng / m L [2.39 ± 1.12 ng / m L] and [2.95 ± 0.86 ng / m L], the differences were statistically significant (P <0.05). The level of AMH in serum of group A was lower than that before treatment [(2.24 ± 1.23) ng / m L [2.97 ± 1.31 ng / m L] and lower than that of group B [(2.92 ± 0.82) ng / m L], the difference was statistically significant (P <0.05). There was no significant difference in B group before treatment (P> 0.05). The level of AMH was negatively correlated with the cumulative dose of CTX and age (P <0.05). Conclusions AMH can be used as an indicator of ovarian damage in women with SLE after using CTX.