Shoenfeld Y, Gurewich Y, Gallant L A, Pinkhas J
Am J Med. 1981 Nov;71(5):773-8. doi: 10.1016/0002-9343(81)90363-6.
The long-term pattern of prednisone-induced leukocytosis was examined in 80 patients. Our results disclosed an extremely variable leukocytic responses, in which the white blood cell count surpassed 20,000/mm3 as early as the first day of treatment, an increase that persisted for the duration of therapy. Although the degree of leukocytosis was related to the dosage administered, it did appear sooner with higher doses. Leukocytosis reached maximal values within two weeks in most cases, after which the white blood cell count decreased, albeit not to pretreatment levels. The leukocytosis was attributed predominantly to a rise in the polymorphonuclear white blood cells, a phenomenon that coincided with monocytosis, eosinopenia and a variable degree of lymphopenia. It can be concluded that even small doses of prednisone, administered over a prolonged period of time, can induce extreme and persistent leukocytosis. This observation is of consequence especially when infection is suspected, particularly in an immunocompromised host. However, a shift to the left in the peripheral white blood cells, i.e., more than 6 percent band forms, and the appearance of toxic granulation may assist in the differential diagnosis between infection, in which the latter are observed, and corticosteroid-induced leukocytosis, in which they are rare.
对80例患者的泼尼松诱导白细胞增多症的长期模式进行了研究。我们的结果显示白细胞反应极为多变，其中白细胞计数早在治疗第一天就超过20,000/mm³，且在治疗期间持续升高。虽然白细胞增多的程度与给药剂量有关，但较高剂量时出现得更早。大多数情况下，白细胞增多在两周内达到最大值，之后白细胞计数下降，尽管未降至治疗前水平。白细胞增多主要归因于多形核白细胞增多，这一现象与单核细胞增多、嗜酸性粒细胞减少和不同程度的淋巴细胞减少同时出现。可以得出结论，即使长期给予小剂量泼尼松也可诱导极端且持续的白细胞增多。这一观察结果尤其在怀疑感染时具有重要意义，特别是在免疫功能低下的宿主中。然而，外周血白细胞核左移，即杆状核细胞超过6%，以及出现中毒性颗粒，可能有助于鉴别观察到后者的感染与罕见这些表现的皮质类固醇诱导的白细胞增多症。
