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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1023-1028. doi: 10.19723/j.issn.1671-167X.2024.06.012

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Ovarian function in patients of childbearing age with systemic lupus erythematosus

Dandan CHEN1,2, Yun LI1, Qingyi LU1, Xiaohong XIANG1, Feng SUN1, Yingni LI1, Jing ZHAO1, Hongyan WANG1, Chun LI*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People' s Hospital, Beijing 100044, China
    2. Department of Laboratory, First Hospital of Qin Huang Dao, Qinhuangdao 066000, Hebei, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Chun LI E-mail:fiona_leechun@163.com
  • Supported by:
    the Horizontal Scientific Research Project of Peking University People' s Hospital(2023-Z-49)

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Abstract:

Objective: To explore the ovarian function and its influencing factors in women of childbearing age with systemic lupus erythematosus (SLE). Methods: A total of 107 female patients diagnosed with SLE at Peking University People' s Hospital from January 2017 to May 2024, aged between 20 and 40 years, were included in the study. At the same time, 40 matched healthy women aged between 20 and 40 years were selected as controls. Serum levels of anti-Müllerian hormone (AMH) were measured using the chemiluminescence method in both the control group and the SLE patients. The general clinical characteristics and medication history (including hormones, immunosuppressants, and biological agents) of the SLE patients were obtained through case retrieval. Changes in serum AMH levels before and after treatment with biological agents in the SLE patients were analyzed. Results: (1) The AMH levels in the SLE patients were significantly lower than those in the healthy control group [1.475 (0.344, 3.030) μg/L vs. 2.934 (1.893, 4.761) μg/L, P < 0.001]. (2) The level of AMH in the SLE patients with normal menstruation was significantly higher than that in the patients with irregular menstruation [1.931 (0.638, 3.414) μg/L vs. 0.335 (0.159, 1.527) μg/L, P=0.004]. No statistical differences were found in clinical characteristics and laboratory indicators between the groups with decreased AMH group and normal AMH group. (3) The multivariate logistic regression analysis revealed that age (OR=1.124, 95%CI: 1.033-1.224, P=0.007) and disease duration (OR=1.100, 95%CI: 1.017-1.190, P=0.018) were identified as significant risk factors for the decline in AMH levels. (4) After 6 months of treatment with telitacicept, the AMH level was significantly higher than that before treatment [2.050 (0.763, 4.259) μg/L vs. 1.988 (0.473, 2.822) μg/L, P=0.043]. There was no significant difference in AMH level between patients receiving rituximab treatment for 6 months [2.026 (0.376, 2.267) μg/L vs. 1.545 (0.503, 3.414) μg/L, P=0.127]. Conclusion: Ovarian function is decreased in SLE patients of childbearing age, and age and disease duration are the risk factors. The utilization of biological agents demonstrates favorable safety profiles regarding ovarian function in childbearing-age patients with SLE.

Key words: Systemic lupus erythematosus, Ovarian function, Anti-Müllerian hormone

CLC Number: 

  • R593.2

Table 1

Demographics characteristics of SLE patients"

Parameters SLE (n=107)
Age/years, M (P25, P75) 31 (25, 34)
Disease duration/years, M (P25, P75) 4 (1, 10)
Rash, n (%) 64 (59.8)
Photosensitivity, n (%) 18 (16.8)
Oral ulcers, n (%) 17 (15.9)
Arthritis, n (%) 62 (57.9)
Serositis, n (%) 31 (29.0)
Renal disorder, n (%) 54 (50.5)
Neurologic disorder, n (%) 30 (28.0)
Hematologic disorder, n (%) 54 (50.5)
Antinuclear antibody positive, n (%) 101 (94.4)
Anti-dsDNA antibody positive, n (%) 66 (60.7)
Anti-Sm antibody positive, n (%) 19 (17.8)
GC, n (%) 74 (69.1)
HCQ, n (%) 69 (64.5)
MMF, n (%) 45 (42.1)
CTX, n (%) 5 (4.7)
RTX, n (%) 20 (18.7)
Telitacicept, n (%) 19 (17.8)

Table 2

Relationship between AMH and clinical symptoms and laboratory parameters in SLE patients"

Parameters AMH normal (n=59) AMH decreased (n=48) U/ χ2 value P value
Age/years, M(P25, P75) 29.00 (24.00, 32.00) 33.00 (28.00, 36.00) 855.0 0.001
Disease duration/years, M (P25, P75) 2.00 (0.50, 7.00) 6.50 (3.00, 12.00) 860.5 < 0.001
Clinical symptoms
Rash, n (%) 33 (55.9) 31 (64.6) 0.824 0.364
   Photosensitivity, n (%) 9 (15.3) 9 (18.8) 0.231 0.631
   Oral ulcers, n (%) 8 (13.6) 9 (18.8) 0.534 0.465
   Arthritis, n (%) 32 (54.2) 30 (62.5) 0.742 0.389
   Serositis, n (%) 19 (32.2) 12 (25.0) 0.667 0.414
   Renal disorder, n (%) 30 (50.8) 24 (50.0) 0.008 0.931
   Neurologic disorder, n (%) 14 (23.7) 16 (33.3) 1.210 0.271
   Hematologic disorder, n (%) 29 (49.2) 25 (52.1) 0.091 0.763
Laboratory parameters
   Antinuclear antibody positive, n (%) 57 (96.6) 44 (91.7) 1.559 0.459
   Anti-dsDNA antibody positive, n (%) 37 (62.7) 28 (58.3) 0.213 0.645
   Anti-Sm antibody positive, n (%) 8 (13.6) 11 (22.9) 1.587 0.208
   IgA, M (P25, P75) 2.285 (1.758, 3.245) 2.800 (1.600, 3.570) 1 236.0 0.414
   IgG, M (P25, P75) 13.70 (10.90, 17.54) 13.68 (9.07, 17.00) 1 322.0 0.794
   IgM, M (P25, P75) 1.085 (0.690, 1.450) 0.826 (0.470, 1.340) 1 078.0 0.066
   C3, M (P25, P75) 0.716 (0.528, 0.437) 0.610 (0.437, 0.943) 1 236.0 0.323
   C4, M (P25, P75) 0.121 (0.080, 0.237) 0.140 (0.080, 0.214) 1 345.0 0.768
Immunosuppressant
   MMF, n (%) 25 (42.4) 20 (41.7) 0.490 0.783
   CTX, n (%) 2 (3.4) 3 (6.3) 0.003 0.953
Biologics
   RTX, n (%) 12/53 (20.3) 8/42 (16.7) 0.452 0.502
   Telitacicept, n (%) 12/53 (20.3) 7/42 (14.6) 0.817 0.366
SLEDAI-2000, M(P25, P75) 9.0 (5.0, 14.0) 9.0 (5.3, 14.0) 1 333.0 0.605

Table 3

Results of binary Logistic regression analysis for decreased AMH"

Variables Univariate Multivariate
B Wald P OR 95%CI B Wald P OR 95%CI
Age 0.141 11.485 0.001 1.152 1.061-1.250 0.117 7.281 0.007 1.124 1.033-1.224
Disease duration 0.123 10.018 0.002 1.131 1.048-1.221 0.095 5.619 0.018 1.100 1.017-1.190
IgA 0.135 0.901 0.343 1.144 0.866-1.512
IgG 0.001 0.001 0.979 1.001 0.947-1.057
IgM -0.306 0.981 0.322 0.736 0.401-1.350
C3 -0.874 1.909 0.167 0.417 0.121-1.442
C4 0.253 0.017 0.895 1.288 0.030-55.334
MMF -0.223 0.553 0.457 0.800 0.444-1.440
CTX 0.642 0.472 0.492 1.900 0.304-11.861
RTX -0.405 0.789 0.374 0.667 0.273-1.631
Telitacicept -0.539 1.284 0.257 0.583 0.230-1.482
SLEDAI-2000 0.008 0.069 0.792 1.008 0.949-1.071

Figure 1

SLE patients' AMH levels before and after six months of treatment with telitacicept or rituximab A, telitacicept; B, rituximab. * P < 0.05; ns, no significance; AMH, anti-Müllerian hormone; SLE, systemic lupus erythematosus."

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