Jia Wan-Yu, Zhang Jian-Jiang
Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Clinical Center of Pediatric Nephrology of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
World J Clin Cases. 2022 Jul 26;10(21):7187-7194. doi: 10.12998/wjcc.v10.i21.7187.
Glucocorticoids (GCs) have been widely used as immunosuppressants and anti-inflammatory agents to treat a variety of autoimmune and inflammatory diseases, and they fully exert their anti-inflammatory and immune-regulating effects in the body. The effect of GCs on white blood cells is an important part of their action. GCs can cause changes in peripheral blood white blood cell counts by regulating the proliferation, differentiation, and apoptosis of white blood cells. Although the total number of white blood cells, neutrophil counts, lymphocytes, and eosinophils increases, the counts of basic granulocytes and macrophages decreases. In addition, GCs can regulate the activation and secretion of white blood cells, inhibit the secretion of a variety of pro-inflammatory cytokines, the expression of chemokines, and promote the production of anti-inflammatory cytokines. For patients on GC therapy, the effects of GCs on leukocytes were similar to the changes in peripheral blood caused by bacterial infections. Thus, we suggest that clinicians should be more cautious in assessing the presence of infection in children with long-term use of GCs and avoid overuse of antibiotics in the presence of elevated leukocytes. GCs work through genomic and non-genomic mechanisms in the human body, which are mediated by GC receptors. In recent years, studies have not fully clarified the mechanism of GCs, and further research on these mechanisms will help to develop new therapeutic strategies.
糖皮质激素（GCs）已被广泛用作免疫抑制剂和抗炎药来治疗多种自身免疫性和炎性疾病，并且它们在体内充分发挥其抗炎和免疫调节作用。GCs对白细胞的作用是其作用的重要组成部分。GCs可通过调节白细胞的增殖、分化和凋亡来引起外周血白细胞计数的变化。虽然白细胞总数、中性粒细胞计数、淋巴细胞和嗜酸性粒细胞增加，但基础粒细胞和巨噬细胞的计数减少。此外，GCs可调节白细胞的活化和分泌，抑制多种促炎细胞因子的分泌、趋化因子的表达，并促进抗炎细胞因子的产生。对于接受GC治疗的患者，GCs对白细胞的影响类似于细菌感染引起的外周血变化。因此，我们建议临床医生在评估长期使用GCs的儿童是否存在感染时应更加谨慎，避免在白细胞升高时过度使用抗生素。GCs在人体内通过基因组和非基因组机制发挥作用，这些机制由GC受体介导。近年来，对GCs的作用机制尚未完全阐明，对这些机制的进一步研究将有助于开发新的治疗策略。
