Thorndike Memorial Laboratory, Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston.
J Exp Med. 1927 Aug 31;46(3):511-39. doi: 10.1084/jem.46.3.511.
In a study of twenty clinical cases with a wide range of diagnoses, repeated total counts of the white cells at 15 minute intervals reveal a large fluctuation at various levels comparable to that found for the normal (1, 2). The granulocytes seem to follow a more or less hourly rhythm, the most marked shift to the left in the Ameth pattern and the moment of greatest percentage of motility coinciding with the peaks. The independence found existing between the peripheral blood concentrations of individual strains of white cells and the red cells, as determined by total and differential counts, their differential response to pathological and pharmacological stimuli, and their normal relative relations, all indicate some separate physiological mechanism of control for each type of cell, either working through, or independently of, their sources of origin. The many factors to which the circulation of the blood, as such, is subject, the complexity of the influences on origin, maturation, delivery, longevity, and destruction of each cell group, the limitations inherent in the present involved, indirect technics of counting, combine to make any single observation subject to grave misinterpretation. The value to the clinician must come in repeated observations, at times when the diagnosis or a therapeutic procedure is in doubt, at frequent intervals, at other times over longer or shorter periods, but always with the relation between consecutive counts, rather than the absolute values, the important point for consideration. Both the red and the white cells probably change their relative concentrations in the peripheral blood from time to time over a considerable range that is quite within normal physiological limits, so that, in theoretical considerations and in practical functional estimations, a zonal concept with adequate individual extremes should always be kept in mind for both physiological and pathological states. A cytological analysis of thirty-two bone marrows from human biopsy and autopsy material shows the striking reciprocity found to exist between the myelocytes and the mature polymorphonuclear leucocytes. This, together with the observed focal uniformity of maturation found in bone marrow, and the periodicity of the fluctuations of the neutrophils in the peripheral blood, leads to the formulation of the hypothesis of a constant functional withdrawal of granulocytes from the peripheral blood with a periodic delivery of new cells from the marrow, which in leucopenia and in leucocytosis represents a depression or a stimulation, respectively, of the normal mechanism. The nature and degree of the response are an approximate index of the cellular factor in the complex of the "resistance" of the particular individual.
在一项涉及 20 例临床病例的广泛诊断研究中，每隔 15 分钟重复进行白细胞总数计数，发现白细胞水平波动较大，与正常情况相当（1、2）。粒细胞似乎遵循着或多或少的每小时节律，在 Ameth 模式中向左移动最为明显，最大运动百分比与峰值同时出现。通过总计数和差异计数确定的外周血中单个白细胞和红细胞之间的浓度、它们对病理和药理刺激的差异反应以及它们正常的相对关系，都表明每种类型的细胞都存在某种独立的生理控制机制，这些机制通过其来源或独立于其来源发挥作用。血液的循环受到许多因素的影响，起源、成熟、传递、寿命和破坏每个细胞群的影响因素也很复杂，目前所涉及的计数技术存在内在的局限性，这些因素结合在一起，使得任何单次观察都可能存在严重的误解。临床医生的价值在于在诊断或治疗过程存在疑问时进行重复观察，在其他时候则需要频繁进行观察，或者在较长或较短的时间内进行观察，但始终要关注连续计数之间的关系，而不是绝对值，这是需要考虑的重要一点。无论是红细胞还是白细胞，其在外周血中的相对浓度可能会在相当大的范围内随时间发生变化，而且这种变化完全在正常生理范围内，因此，在理论考虑和实际功能评估中，对于生理和病理状态，都应始终牢记一个具有适当个体极端的区域概念。对 32 例人类活检和尸检骨髓的细胞学分析表明，发现骨髓中存在明显的成熟髓细胞和成熟多形核白细胞之间的互惠关系。这一点，加上在骨髓中观察到的成熟局部一致性，以及外周血中性粒细胞波动的周期性，导致提出了一个假说，即粒细胞从外周血中持续有功能地撤出，并定期从骨髓中输送新细胞，这在外周血白细胞减少症和白细胞增多症中分别代表正常机制的抑制或刺激。这种反应的性质和程度是特定个体“抵抗力”复杂因素中细胞因素的近似指标。
