目的

        ：系统性红斑狼疮(SLE)和系统性硬化症(SSc)均是女性多见的自身免疫性疾病，因此有关男性患者的研究相对较少。本研究旨在比较糖皮质激素和环磷酰胺(CYC)对男性SLE和SSc患者性激素水平的影响。

方法：

        收集71例男性SLE患者和29例男性SSc患者以及与之年龄相匹配的男性对照人群空腹血样，并检测血样中性激素水平。采用聚类分析的方法明确相应的激素谱。

结果

        ：与匹配的对照人群相比，男性SLE患者具有更高水平的促黄体激素，且生物活性睾酮缺乏的频率更高。糖皮质激素使用剂量与生物活性睾酮的水平呈负相关。聚类分析的SLE患者亚群发现存在高水平的促卵泡激素、促黄体激素和催乳素，以及低水平的生物活性睾酮，且与每日大剂量的糖皮质激素使用量相关。对于SSc男性患者，与匹配的对照人群相比，睾酮和生物活性睾酮水平更低。对于SLE和SSc患者，既往使用环磷酰胺与低水平的生物活性睾酮相关。

结论

        ：本研究强调了糖皮质激素对于男性SLE患者性腺功能的负面影响。此外，既往使用环磷酰胺均可损害男性SLE或SSc患者的血清生物活性睾酮的水平。临床医生更应关注男性风湿病患者性腺功能减退发生的可能性。关于是否需要激素补充仍需要进一步评估。

        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.