Background Women with SLE have a higher risk of developing menstrual irregularities compared to a healthy population. Anti-Müllerian hormone (AMH) has been shown to have great promise as a possible marker of ovarian function. Some studies have suggested that AMH may be an early indicator of waning ovarian function in chemotherapy patients, and may be superior to current markers of ovarian reserve. However, the ovarian reserve of SLE patients receiving cyclophosphamide (CYC) therapy is still unclear.
Objectives To evaluate the serum level of AMH in female patients with SLE and identify the correlations between AMH with age and CYC therapy.
Methods 77 SLE female patients and 38 control healthy women ages 20 to 40 years who had regular menstrual cycles were recruited in this study. AMH was measured by an enzyme linked immunosorbent assay (ELISA) kit. Follicle-stimulating hormone (FSH) and estradiol (E2) were detected by microparticle enzyme immunoassay (MEIA) at the third day of the menstrual cycle, as well as transvaginal ultrasound was performed to record the antral follicle counts (AFC) of bilateral ovary.
Results The mean age of SLE patients was 29.1±5.2 years (ranging from 20 to 40 years), and the mean duration was 2.7±2.4 years. The mean level of serum AMH was1.5±1.3ng/ml and AFC was 9.6±6.6, respectively. The level of AMH had a significantly positive correlation with the AFC [correlation coefficient (r) = 0.9, P<0.001]. Patients were divided into three groups: SLE-CYC group: SLE patients exposed to CYC therapy (n=35), SLE group: SLE patients had not been exposed to CYC therapy (n=42) and control group (n=38). The AMH level and AFC of control group were significantly higher than SLE group and SLE-CYC group (AMH: 3.4±1.8 ng/ml versus 1.9±1.2 ng/ml versus 1.1±1.1 ng/ml, P<0.001; AFC: 13.9±5.7 versus 11.4±6.6 versus 7.5±6. 2, P<0.001). The AMH level and AFC of SLE group were significantly higher than SLE-CYC group (P=0.003 and P=0.017, respectively) but lower than control normal group (P<0.003 and P<0.001, respectively). There was no difference in FSH and E2 among three groups. The level of AMH of SLE patients increased until peaking at 26 to 30 years of age, and then decreased along with aging. Compared with patients over the age of 30 years old, patients ages 30 years and younger had significantly higher level of AMH (1.9±1.3 ng/ml versus1.0±1.1 ng/ml, P=0.004). The Spearman's correlation analysis indicated that the level of AMH was negatively correlated with the cumulative dose of CYC (r= -0.4, P<0.001).
Conclusions The AMH level was positively correlated with AFC. AMH was a more sensitive marker reflecting the function of ovarian reserve compared with FSH and E2. AMH was associated with age and the cumulative dose of CYC. SLE patients ages 30 years and older and exposed to CYC with the cumulative dose over 10g should require serious consideration about the administration of CYC. AMH could be applied to direct the CYC rational administration as a marker for ovarian reserve.
Disclosure of Interest None declared
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