Voon H Y, Leong M S, Li C W, Bujang A, Suharjono H
Sarawak General Hospital, Department of Obstetrics & Gynaecology, Sarawak, Malaysia.
Sarawak General Hospital, Clinical Research Centre, Sarawak, Malaysia.
Med J Malaysia. 2017 Oct;72(5):259-263.
In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies.
Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone.
The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours.
In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.
在处理早产过程中，白细胞总数呈上升趋势引起产科医生的关注，提示可能存在潜在的感染病因。尽管孕期预计会出现轻度白细胞增多，但除动物模型和少数人体研究外，关于皮质类固醇给药后白细胞增多的模式尚无详细描述。
招募了73例因早产或临产前剖宫产而需要产前使用皮质类固醇的连续患者，并给予标准疗程的12mg磷酸地塞米松，每12小时一次。在给药前、第一剂地塞米松给药后6小时和36小时采集静脉血样本。
白细胞总数基线时为10.31±2.62，6小时时为11.44±3.05，36小时时为12.20±3.49。中性粒细胞与淋巴细胞比值分别为3.60±1.31、8.73±3.63和3.24±1.49，反映出相对中性粒细胞增多和淋巴细胞减少，至36小时恢复正常。
与先前研究不同，我们发现白细胞总数仅轻微增加约10%。我们研究中描述的微小变化通常不会引起任何临床关注，尽管如果观察到更高水平则应保持警惕。
