Panesar N S
Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Med Hypotheses. 2008 Aug;71(2):298-301. doi: 10.1016/j.mehy.2008.03.019. Epub 2008 Apr 29.
Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-03 caused morbidity in over 8000 individuals and mortality in 744 in 29 countries. Lymphopenia along with neutrophilia was a feature of SARS, as it is in respiratory syncytial virus (RSV) and Ebola infections, to name a few. Direct infestation of lymphocytes, neutrophils and macrophages by SARS coronavirus (CoV) has been debated as a cause of lymphopenia, but there is no convincing data. Lymphopenia can be caused by glucocorticoids, and thus any debilitating condition has the potential to induce lymphopenia via stress mechanism involving the hypothalamic-pituitary-adrenal axis. Cortisol levels are elevated in patients with RSV and Ebola, and cortisol was higher in SARS patients with lymphopenia before any steroid therapy. Glucocorticoids also down-regulate the production of proinflammatory lymphokines. Because of the insidious presentation, SARS was treated with antibacterial, antiviral and supra-physiological doses of glucocorticoids. Treatment with glucocorticoids complicated the issue regarding lymphopenia, and certainly calls into question the status of lymphokines and their prognostic implications in SARS.
2002 - 2003年严重急性呼吸综合征（SARS）的爆发在29个国家导致8000多人发病，744人死亡。淋巴细胞减少伴中性粒细胞增多是SARS的一个特征，呼吸道合胞病毒（RSV）感染和埃博拉感染等也有此特征。SARS冠状病毒（CoV）对淋巴细胞、中性粒细胞和巨噬细胞的直接侵袭一直被认为是淋巴细胞减少的一个原因，但尚无确凿数据。糖皮质激素可导致淋巴细胞减少，因此任何使身体虚弱的状况都有可能通过涉及下丘脑 - 垂体 - 肾上腺轴的应激机制诱发淋巴细胞减少。RSV感染和埃博拉感染患者的皮质醇水平会升高，在未接受任何类固醇治疗之前，淋巴细胞减少的SARS患者的皮质醇水平更高。糖皮质激素还会下调促炎淋巴因子的产生。由于SARS的症状隐匿，曾使用抗菌、抗病毒药物以及超生理剂量的糖皮质激素进行治疗。糖皮质激素治疗使淋巴细胞减少问题变得复杂，这无疑让人质疑淋巴因子的状况及其在SARS中的预后意义。
