目的
：系統(tǒng)性紅斑狼瘡(SLE)和系統(tǒng)性硬化癥(SSc)均是女性多見的自身免疫性疾病,，因此有關(guān)男性患者的研究相對較少,。本研究旨在比較糖皮質(zhì)激素和環(huán)磷酰胺(CYC)對男性SLE和SSc患者性激素水平的影響。
方法：
收集71例男性SLE患者和29例男性SSc患者以及與之年齡相匹配的男性對照人群空腹血樣,，并檢測血樣中性激素水平,。采用聚類分析的方法明確相應(yīng)的激素譜。
結(jié)果
：與匹配的對照人群相比,，男性SLE患者具有更高水平的促黃體激素，且生物活性睪酮缺乏的頻率更高,。糖皮質(zhì)激素使用劑量與生物活性睪酮的水平呈負(fù)相關(guān),。聚類分析的SLE患者亞群發(fā)現(xiàn)存在高水平的促卵泡激素、促黃體激素和催乳素,，以及低水平的生物活性睪酮，且與每日大劑量的糖皮質(zhì)激素使用量相關(guān),。對于SSc男性患者,，與匹配的對照人群相比，睪酮和生物活性睪酮水平更低,。對于SLE和SSc患者，既往使用環(huán)磷酰胺與低水平的生物活性睪酮相關(guān),。
結(jié)論
：本研究強調(diào)了糖皮質(zhì)激素對于男性SLE患者性腺功能的負(fù)面影響,。此外，既往使用環(huán)磷酰胺均可損害男性SLE或SSc患者的血清生物活性睪酮的水平,。臨床醫(yī)生更應(yīng)關(guān)注男性風(fēng)濕病患者性腺功能減退發(fā)生的可能性。關(guān)于是否需要激素補充仍需要進(jìn)一步評估,。
END
附原文：
OBJECTIVE
: Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are autoimmune diseases that predominantly affect female patients, and therefore fewer investigations have been conducted in men. The aim of this study was to analyze sex hormone levels in male patients with SLE and those with SSc, compared to matched controls, in relation to the use of corticosteroids and cyclophosphamide (CYC).
METHODS
: Sex hormone levels were measured in fasting blood samples from male patients with SLE (n = 71) and those with SSc (n = 29) and compared to population-based, age-matched male controls. Relevant hormone profiles were identified using cluster analysis.
RESULTS
:Male SLE patients had higher levels of luteinizing hormone (LH) (P < 0.0001) and more frequent bioactive testosterone deficiency (P = 0.02) than their matched controls. The current dosage of prednisolone correlated inversely with the levels of bioactive testosterone (r = -0.36, P = 0.03). Cluster analysis identified a subset of SLE patients with increased levels of follicle-stimulating hormone, LH, and prolactin as well as lower levels of bioactive testosterone (P < 0.0001) in relation to higher daily doses of prednisolone. In male SSc patients, levels of testosterone (P = 0.03) and bioactive testosterone (P = 0.02) were
significantly lower than those in matched controls. Use of CYC during the previous year was associated with lower bioactive testosterone levels in both SLE patients (P = 0.02) and SSc patients (P = 0.01), after adjustment for age.
CONCLUSION
:The results of this study highlight the negative impact of corticosteroids on gonadal function in men with SLE. Furthermore, use of CYC during the year prior to study inclusion impaired bioactive testosterone levels in male patients with either SLE or SSc. Physicians should be more aware of the possibility of hypogonadism in male patients with autoimmune diseases. The need for hormonal supplementation remains to be formally evaluated in these patients.
引自：Arnaud L, Nordin A, Lundholm H, Svenungsson E, Hellbacher E, Wikner J, Zickert A, Gunnarsson I.Effect of Corticosteroids and Cyclophosphamide on Sex Hormone Profiles in Male Patients With Systemic Lupus Erythematosus or Systemic Sclerosis. Arthritis Rheumatol. 2017 Jun;69(6):1272-1279. doi: 10.1002/art.40057. Epub 2017 May 4.
