Background Systemic lupus erythematosus (SLE) is a clinically autoimmune disease characterized by production of autoantibodies and immune complex deposition. That induces multiple organ damages such as nephritis, pneumonitis and central nervous system (CNS) lupus et al. Moreover, SLE which mainly occurs in reproductive woman could threaten ovarian function. In recent years, ovarian reserve dysfunction in SLE are attracting increasing attentions. Especially cyclophosphamide (CYC) therapy was already well known as a higher risk to result in premature ovarian failure (POF) 1,2. However, few research has been performed in association between SLE itself and ovarian reserve. POF which is a critical cause of secondary amenorrhea and infertility still has not been treated effectively until now. Accordingly, an early precaution is important to make an informed decision about impaired ovarian reserve in SLE.
Objectives To study the association between systemic lupus erythematosus (SLE) itself and strongly reduced Anti-Müllerian Hormone (AMH) values.
Methods SLE women during reproductive ages 18–40 years were recruited compared with age-matched healthy controls (HC). AMH Levels and its relationship to clinical parameters and disease activity were investigated.
Results Totally 91 SLE patients were enrolled (means ± SD age 28.38±5.80 years; SLE duration 47.15±44.70 months; SLE-2k scores 6.48±7.02). There were 73 subjects without cyclophosphamide therapy (SLE-CYCfree), 18 subjects previously exposed to CYC (SLE-CYC) and 79 HC. AMH values in SLE-CYC cases decreased significantly than HC and SLE-CYCfree (1.38±1.93 versus 4.10±3.40, P=0.002; 1.38±1.93 versus 3.62±3.61, P=0.013). No different was found between SLE-CYCfree and HC groups (P=0.377). Strong reduced AMH values (<0.5 μg/L) were identified in 12 of 73 (16.4%) SLE-CYCfree patients and 1 of 79 (1.3%) HC (P=0.001, OR=15.344). Furthermore, 10 (31.2%) SLE-CYCfree women aged ≥30 years had low AMH levels compared with 2 (4.9%) patients less than 30 years (P=0.004, OR=8.86). 29.6% (8/27) SLE populations over 3 year-duration of illness and 8.7% (4/46) in cases with less than 3 years were observed (P=0.046, OR=4.42). No difference reached statistical significance in SLEDAI-2K, Complement C3 and C4, IgG and IgM between SLE-CYCfree and SLE-CYC groups.
Conclusions SLE was confirmed to be closely associated with low AMH levels. SLE could play a critical role in development of abnormal ovarian reserve. And moreover, over 3-year disease duration and ages over 30 years in reproductive-aged SLE women might enhance the risk of impaired ovarian reserve.
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Disclosure of Interest None declared