Systemic lupus erythematosus (SLE) is a chronic, multiorgan, systemic autoimmune disease that is more common in women than men and is typically diagnosed during reproductive age, necessitating sex-specific considerations in care. In women there is no substantive evidence to suggest that SLE reduces fertility, but subfertility may occur as a result of active disease, immunosuppressive drugs, and age-related declines in fertility related to delays in childbearing. Although pregnancy outcomes have improved, SLE still poses risks in pregnancy that contribute to poorer maternal and fetal outcomes. Cyclophosphamide, an important agent for the treatment of severe or life-threatening lupus, may adversely affect fertility, particularly with increases in dose and patient age. Fertility preservation techniques are therefore an important consideration for women and men before cytotoxic treatment. There is mixed evidence as to whether exogenous estrogen in the form of oral contraceptive pills or hormone replacement therapy may increase the risk for the development of SLE, but among women with SLE already diagnosed, combined oral contraceptive pills and hormone replacement therapy do not confer risk for severe flare and remain important in reproductive care. The higher incidence of SLE in women may nonetheless be attributable to effects of endogenous estrogen, as well as failures in X chromosome inactivation, increased Toll-like receptor gene products, and changes in microRNA function. A greater appreciation of the biological underpinnings and consequences of sex differences in SLE may lead to more targeted treatments and improved outcomes for patients with SLE.

中文翻译：

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系统性红斑狼疮的性别差异：流行病学，临床考虑因素和疾病发病机理。

系统性红斑狼疮（SLE）是一种慢性多器官系统性自身免疫性疾病，在女性中比男性更常见，并且通常在育龄期间被诊断出来，因此需要在护理时针对性别进行特定考虑。在女性中，没有实质性证据表明SLE会降低生育能力，但由于活动性疾病，免疫抑制药物以及与生育延迟有关的与年龄相关的生育能力下降，可能会导致亚生育能力下降。尽管妊娠结局有所改善，但SLE仍然在妊娠中构成风险，导致孕产妇和胎儿的结局较差。环磷酰胺是治疗严重或威胁生命的狼疮的重要药物，可能会对生育力产生不利影响，尤其是随着剂量和患者年龄的增加而增加。因此，在细胞毒性治疗之前，生育力保留技术是男女的重要考虑因素。关于口服避孕药或激素替代疗法形式的外源性雌激素是否会增加发生SLE的风险，目前有混合的证据，但是在已被诊断为SLE的女性中，口服避孕药和激素替代疗法联合使用不会带来危险对于严重的耀斑，在生殖保健中仍然很重要。女性中SLE的发生率较高可能归因于内源性雌激素的作用，以及X染色体失活失败，Toll样受体基因产物增加以及microRNA功能改变。