摘要
目的 探讨促性腺释放激素类似物渊Gn RHa冤联合环磷酰胺渊CTX冤治疗对系统性红斑狼疮渊SLE冤患者病情的影响袁以及Gn RHa作为CTX治疗的SLE患者卵巢保护剂的安全性遥方法 选取2013年3月-2014年12月在北京大学深圳医院风湿科确诊为SLE的育龄女性24例袁根据是否使用Gn RHa分为CTX＋Gn RHa组和CTX组袁每组各12例遥采用双能X线骨密度仪检测两组患者腰椎渊L1-L4正位冤骨密度曰比较两组患者治疗前后病情尧CTX的累积治疗量尧骨密度及治疗后副作用遥结果 淤SLE病情院治疗后两组SLE患者临床症状均消失袁两组治疗前后系统性红斑狼疮疾病活动指数渊SLEDAI冤评分组内比较袁差异均有高度统计学意义渊t=23.534尧19.187袁均P=0.000冤曰治疗后两组SLEDAI评分比较袁差异有高度统计学意义渊t=3.425袁P=0.002冤遥于CTX的累积治疗量院CTX＋Gn RHa组与CTX组的CTX的累积治疗量分别为渊6.9依2.0冤尧渊7.0依1.5冤g袁两组比较差异无统计学意义渊t=0.217袁均P=0.830冤遥盂骨密度院两组SLE患者治疗前后腰椎渊L1-L4正位冤骨密度值比较袁差异均无统计学意义渊t=0.126尧0.175袁P=0.901尧0.863冤遥榆治疗后的副作用尧围绝经期症状及月经改变院CTX＋Gn RHa组在使用第2次Gn RHa后均出现闭经袁并伴有不同程度的潮热尧多汗尧睡眠困难等低雌激素症状袁而停用Gn RHa尧月经恢复后上述症状缓解消失遥CTX组有7例出现月经不规则袁其中3例月经淋漓不尽袁4例月经稀发袁但均无低雌激素症状遥结论 Gn RHa联合CTX治疗对SLE患者的病情无明显的负面影响袁Gn RHa具有保护CTX治疗中SLE患者卵巢的功能袁但其作为CTX治疗的SLE患者的卵巢功能保护剂的安全性及有效性仍有待进一步证实。
Objective To study the effect of gonadotropin releasing hormone analogue（Gn RHa） combined with Cyclophosphamide（CTX） for patients with systemic lupus erythematosus（SLE）, and the safety of Gn RHa as the ovarian protective agent for CTX treatment in patients with SLE. Methods 24 female patients with SLE of childbearing age from March 2013 to December 2014 in Peking University Shenzhen Hospital were recruited and divided into the CTX＋ Gn RHa group（n=12） and CTX group（n=12） according to whether using Gn RHa. While dual-energy X-ray absorptiometry was used to measure bone mineral density（BMD） of lumbar 1-4（L1-L4 posterior-anterior position）. SLE conditions between the two groups before and after the treatments, accumulation of CTX, BMD, as well as side effects after the treatments of two groups were compared. Results 1SLE conditions： the clinical symptoms of patients in two groups were disappeared after treatments. There were significant differences in SLE disease activity index（SLEDAI）scores within the group before and after the treatments（t=23.534, 19.187; all P=0.000）, while also significant differences in SLEDAI scores between the two groups after the treatments（t=3.425, P=0.002）. 2The accumulation of CTX： the accumulation of CTX were（6.9±2.0）,（7.0±1.5） g, respectively in the CTX ＋ Gn RHa and CTX group, with no statistically significant differences（t=0.217, P=0.830）. 3 BMD：there were no statistically significant differences in lumbar spine BMD before and after the treatments within two groups（t=0.126, 0.175; P=0.901, 0.863）. 4Side effects, perimenopausal symptoms and menstrual changes after the treatments：amenorrhoea appeared after using the second Gn RHa in the CTX ＋ Gn RHa group, which accompanied by varying degrees of low estrogen symptoms such as hot flash, sweating, sleep difficulties. While menstruation recovered and low estrogen symptoms disappeared after stopping Gn RHa. 7 cases appeared irregular menstruation, including 3 cases of menstrual dripping endless, 4 cases of oligomenorrhea, but without low estrogen symptoms in the CTX group. Conclusion Negative effect on SLE patients treated with Gn RHa combined CTX, while Gn RHa may protect the existing ovarian function of SLE treated with CTX, and Gn RHa as the ovarian protective agent for CTX treatment in SLE is whether safe or effective still need further clinical studies to confirm.
出处
《中国医药导报》
CAS
2015年第22期23-26,58,共5页
China Medical Herald
基金
广东省深圳市科技研发资金项目(JCYJ20130402114317405)
关键词
系统性红斑狼疮
环磷酰胺
卵巢保护
促性腺释放激素类似物
Systemic lupus erythematosus
Cyclophosphamide
Ovary protection
Fertility preservation
Gonadotropin releasing hormone analogue
