哮喘急性发作患者外周血白细胞计数升高与糖皮质激素使用的关系

Relationship between use of glucocorticosteriod and elevation of peripheral white blood cells in acute asthma

目的：明确哮喘患者急性发作时外周血白细胞（ＷＢＣ）升高与静脉糖皮质激素（ＧＣＳ）用量之间的关系。方法：哮喘患者６５ 例，分为重度发作组３５ 例和轻、中度发作组３０例。结果：在重度组，第１ 次ＷＢＣ计数与此前ＧＣＳ累积用量之间存在显著相关性（ｒ＝ ０．６５３ ４，Ｐ＜ ０．００１）。而在轻、中度组，上述两者之间则无相关性（ｒ＝ ０．３５０ ７，Ｐ＞ ０．０５）。在重度组，ＷＢＣ＞ １０．０×１０９ ／Ｌ的持续时间为（１２．５±６．５）日。随着ＧＣＳ每日用量的减少，ＷＢＣ计数亦下降。此间患者ＷＢＣ计数均值与每日ＧＣＳ平均用量之间有相关性（ｒ＝ ０．４０３ ４，Ｐ＜ ０．０５）。哮喘急性发作患者入院时的细菌性呼吸道感染（ＲＴＩ）率仅为１０．８％ 。结论：鉴于细菌性ＲＴＩ并非哮喘急性发作的主要诱因，且ＷＢＣ计数的升高与ＧＣＳ的使用密切相关，故入院前或入院时已使用大剂量ＧＣＳ的哮喘患者，在无其他ＲＴＩ表现时，其外周血ＷＢＣ计数升高并不能提示有细菌性ＲＴＩ。因此，对这类哮喘患者无需给予较强的抗生素治疗。

Objective:To investigate the relationship between elevation of peripheral white blood cell (WBC) counts and the dosage of glucocorticosteroid (GCS).Methods:65 hospitalized patients with acute asthma were analysed for the incidence of bacterial respiratory tract infection (RTI),peripheral WBC counts and the dosage of GCS.All cases were divided into severe asthma group and mild to moderate asthma group.Results:In severe asthma group,WBC counts tested for the first time had a strong correlation with the accumulated dosages of GCS ( r =0 653 4, P <0 001),while there was no marked correlation between WBC counts and dosges of GCS in mild to moderate group.WBC counts exceeding 10 0×10 9/L were lasted (12 5±6 5) days in patients with severe asthma,and it gradually decreased along with the reduction of GCS dosage.Following the use of GCS,there was also a obvious relationship between the average WBC counts and the average GCS dosage every day ( r =0 403 4, P <0 05) in severe group.The total incidence of bacterial RTI was 10 8%.Conclusions:It is suggested that,if the acute asthmatics had been given large amounts of GCS before or when admitted to hospital and without presentation of bacterial RTI,the elevation of WBC counts might not merely indicate bacterial RTI.So,it is unnecessary to use strong antibiotic treatment for these patients.