Heideman M, Bengtsson A
Acta Chir Scand Suppl. 1985;526:48-55.
High-dose corticosteroids (HDC) will influence cellular as well as humoral participants of the immune response. The lymphoid tissue will decrease in size and weight after prolonged treatment with HDC. Lymphocyte functions will be impaired. Reduced synthesis of B- as well as T-lymphocytes will be seen. The inhibitory effect on B-cell function can be observed both as decreased serum levels of immunoglobulins and as impaired binding of antibodies and complement to the cellular surface. Reduced T-cell function indicated by impaired stimulation by PHA and porkweed as well as by impaired lymphokinin effects on leukocyte migration inhibition has been reported. Reduced lymphocyte adherence to antigen and suppressed lymphocyte reaction have also been observed. Humoral factors involved in chemotaxis, opsonisation, phagocytosis, vascular permeability leading to leakage of fluid and cells and factors involved in lysis of antigens are impaired. This can be explained partly by the observed reduced complement activation via the alternative as well as the classical pathway in association with HDC therapy. Acute processes with increased vascular permeability and accumulation of leukocytes as impairing factors could be influenced beneficially by HDC therapy. This positive effect can be seen in treatment of septic shock or rejection of a transplant. However, if sepsis or rejection is not rapidly reversed, complications such as multisystem organ failure and bacteremia are prone to appear.
大剂量皮质类固醇（HDC）会影响免疫反应的细胞和体液参与者。长期使用HDC治疗后，淋巴组织的大小和重量会减小。淋巴细胞功能会受损。会观察到B淋巴细胞和T淋巴细胞的合成减少。对B细胞功能的抑制作用可表现为血清免疫球蛋白水平降低以及抗体和补体与细胞表面结合受损。据报道，PHA和藜对T细胞功能的刺激受损以及淋巴激肽对白细胞迁移抑制作用受损表明T细胞功能降低。还观察到淋巴细胞对抗原的黏附减少和淋巴细胞反应受到抑制。参与趋化作用、调理作用、吞噬作用、导致液体和细胞渗漏的血管通透性以及参与抗原裂解的体液因子均受损。这部分可以通过观察到与HDC治疗相关的替代途径以及经典途径的补体激活减少来解释。血管通透性增加和白细胞积聚等急性过程作为损害因素，HDC治疗可能会对其产生有益影响。这种积极作用在感染性休克或移植排斥反应的治疗中可见。然而，如果败血症或排斥反应不能迅速逆转，多系统器官衰竭和菌血症等并发症很容易出现。
