糖皮质激素与感染造成外周血白细胞计数升高的鉴别

目的：探讨患者应用糖皮质激素后出现白细胞升高是糖皮质激素的作用还是感染加重，注意分析可避免抗菌药物的滥用，节约医疗成本。方法收集2011年1月至2012年12月于该科住院和门诊治疗的74例患者，根据其病种及治疗方案分为非感染激素组（n＝15）、感染非激素组（n＝29）和感染激素组（n＝30），分别在糖皮质激素和（或）抗菌药物治疗0、3、7 d时采集静脉血，对其外周血白细胞计数（WBC）、C反应蛋白（CRP）及外周白血细胞形态进行检测。结果与治疗同期感染非激素组比较，感染激素组在应用糖皮质激素3 d和7 d后WBC显著升高（P＜0．01）；两激素组在应用糖皮质激素3 d和7 d后WBC无显著差异（P＞0．05），两激素组外周血涂片可见较多分叶核中性粒细胞（P＜0．05）。而感染激素组与感染非激素组比较，CRP变化无显著差异（P＞0．05）。结论糖皮质激素升高外周血白细胞，以升高中性粒细胞为主，可以以CRP及外周血涂片结果为参考指标了解患者感染控制情况。

How to identify the increase of peripheral white blood cells caused by glucocorticoid and infection

Objective To distinguish the increase of white blood cells after glucocorticoid is the adverse reaction of glucocor‐ticoid or infection aggravated .If we can analyse it properly ,the abuse of antimicrobials and waste of medical could be avoid re‐source .Methods 74 patients which were in our hospital from 2011 .1 to 2012 .12 were recruited into this study .They were divided into three groups ,including non‐infection with glucocorticoid(n=15) ,infection without glucocorticoid(n=29) and infection with glucocorticoid(n=30) according to disease and therapies .After being treated 0 day ,3 days ,7 days ,venous blood of patients were collected to detect white blood count ,CRP and morphology of leukocyte .Results The group of non‐infection with glucocorticoid applied glucocorticoid after 3 days and 7days ,WBC was increased significantly(P<0 .01 ,respectively) .And compare with the group of infection without glucocorticoid ,more band neutrophils could be seen in peripheral blood smear of the other two(P< 0 .05) . While there was no difference on level of CRP between the groups of infection without glucocorticoid and infection with glucocorti‐coid(P>0 .05) .Conclusion Glucocorticoid rise the count of WBC in peripheral blood especially the neutrophil .We can evaluate in‐fectious status by the level of CRP and the count of band neutrophils in peripheral blood smear .