Fauci A S, Dale D C, Balow J E
Ann Intern Med. 1976 Mar;84(3):304-15. doi: 10.7326/0003-4819-84-3-304.
The administration of glucocorticosteroids results in a wide range of effects on inflammatory and immunologically mediated disease processes. Glucocorticosteroids cause neutrophilic leukocytosis together with eosinopenia, monocytopenia, and lymphocytopenia. A principal mechanism whereby corticosteroids suppress inflammation is their impeding the access of neutrophils and monocytes to an inflammatory site. Granulocyte function is relatively refractory, whereas monocyte-macrophage function seems to be particularly sensitive to corticosteroids. Corticosteroid administration causes a transient lymphocytopenia of all detectable lymphocyte subpopulations, particularly the recirculating thymus-derived lymphocyte. The mechanism of this lymphocytopenia is probably a redistribution of circulating cells to other body compartments. There is considerable disagreement about the direct effects of corticosteroid administration on human lymphocyte function. The corticosteroid regimen should be adjusted to attain maximal therapeutic benefit with minimal adverse side effects. Often, alternate-day dosage regimens effectively maintain disease remission with minimization or lack of Cushingoid and infectious complications.
糖皮质激素的给药会对炎症和免疫介导的疾病过程产生广泛影响。糖皮质激素会导致中性粒细胞增多，同时伴有嗜酸性粒细胞减少、单核细胞减少和淋巴细胞减少。糖皮质激素抑制炎症的主要机制是阻碍中性粒细胞和单核细胞进入炎症部位。粒细胞功能相对不易受影响，而单核细胞 - 巨噬细胞功能似乎对糖皮质激素特别敏感。给予糖皮质激素会导致所有可检测到的淋巴细胞亚群出现短暂性淋巴细胞减少，尤其是循环中的胸腺来源淋巴细胞。这种淋巴细胞减少的机制可能是循环细胞重新分布到身体的其他部位。关于糖皮质激素给药对人淋巴细胞功能的直接影响存在相当大的分歧。应调整糖皮质激素治疗方案，以在最小化不良副作用的情况下获得最大治疗益处。通常，隔日给药方案可有效维持疾病缓解，同时将库欣综合征和感染性并发症降至最低或避免发生。
