Shi Shenyun, Zou Ruyi, Li Rui, Zhao Tingting, Wu Chao, Xiao Yonglong, Feng Xuebing, Chen Lulu
Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, China.
Clin Rheumatol. 2025 Jun;44(6):2421-2430. doi: 10.1007/s10067-025-07425-9. Epub 2025 Apr 9.
Invasive pulmonary aspergillosis (IPA) is a potentially fatal complication in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The aim of this study is to investigate the clinical significance of CD3 + CD4 + T cells counts in CTD-ILD with IPA patients.
This retrospective study included 152 CTD-ILD patients admitted to a single center in China between January 2018 and June 2020. A total of 54 CTD-ILD patients with IPA were assigned to the CTD-ILD with IPA group, while 98 uninfected CTD-ILD patients were assigned to the control group. Serum CD3 + CD4 + T cells counts were compared between the above-mentioned two groups, and the correlations between CD3 + CD4 + T cells counts and the clinical features, mortality of CTD-ILD with IPA were also evaluated.
CTD-ILD patients with IPA had significantly lower CD3 + CD4 + T cells counts than those with CTD-ILD without IPA (P < 0.001). The area under the receiver operating characteristic curve (AUROC) of discriminating CTD-ILD with IPA from CTD-ILD without IPA was 0.800 (95% CI, 0.722-0.878, P < 0.001). Correlation analyses showed that serum CD3 + CD4 + T cells counts were positively correlated with PaO2/FiO2 ratio(r = 0.317, P = 0.034) and negatively correlated with C reactive protein (CRP) (r = - 0.358, P = 0.009), erythrocyte sedimentation rate (ESR) (r = - 0.346, P = 0.014), and lactate dehydrogenase (LDH) (r = - 0.306, P = 0.026). In addition, 30 decedents with CTD-ILD infected IPA exhibited lower values of CD3 + CD4 + T cells compared with 24 survivors (P = 0.041). Furthermore, CD3 + CD4 + T cells counts were a prognostic factor and also associated with a higher mortality rate (log-rank test, P = 0.003).
CD3 + CD4 + T cells counts could be a useful serum indicator associated with occurrence of IPA in CTD-ILD. Moreover, decreased CD3 + CD4 + T cells counts were associated with a poor survival of IPA in CTD-ILD patients. Key Points • CTD-ILD patients with IPA had significantly lower CD3+CD4+T cells counts than those with CTD-ILD without IPA. • Correlation analyses showed that serum CD3+CD4+T cells counts were positively correlated with PaO2/FiO2 ratio and negatively correlated with C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH). • Decreased CD3+CD4+T cells counts were associated with a poor survival of IPA in CTD-ILD patients.
侵袭性肺曲霉病（IPA）是结缔组织病相关间质性肺病（CTD-ILD）患者潜在的致命并发症。本研究旨在探讨CTD-ILD合并IPA患者中CD3+CD4+T细胞计数的临床意义。
本回顾性研究纳入了2018年1月至2020年6月在中国某单一中心住院的152例CTD-ILD患者。将54例合并IPA的CTD-ILD患者纳入CTD-ILD合并IPA组，98例未感染的CTD-ILD患者纳入对照组。比较上述两组患者的血清CD3+CD4+T细胞计数，并评估CD3+CD4+T细胞计数与CTD-ILD合并IPA患者的临床特征、死亡率之间的相关性。
CTD-ILD合并IPA患者的CD3+CD4+T细胞计数显著低于未合并IPA的CTD-ILD患者（P<0.001）。鉴别CTD-ILD合并IPA与未合并IPA的CTD-ILD患者的受试者工作特征曲线（AUROC）下面积为0.800（95%CI，0.722-0.878，P<0.001）。相关性分析显示，血清CD3+CD4+T细胞计数与PaO2/FiO2比值呈正相关（r=0.317，P=0.034），与C反应蛋白（CRP）（r=-0.358，P=0.009）、红细胞沉降率（ESR）（r=-0.346，P=0.014）和乳酸脱氢酶（LDH）（r=-0.306，P=0.026）呈负相关。此外，30例死于CTD-ILD合并IPA的患者的CD3+CD4+T细胞值低于24例存活患者（P=0.041）。此外，CD3+CD4+T细胞计数是一个预后因素，也与较高的死亡率相关（对数秩检验，P=0.003）。
CD3+CD4+T细胞计数可能是与CTD-ILD中IPA发生相关的有用血清指标。此外，CTD-ILD患者中CD3+CD4+T细胞计数降低与IPA的不良生存相关。要点：•CTD-ILD合并IPA患者的CD3+CD4+T细胞计数显著低于未合并IPA的CTD-ILD患者。•相关性分析显示，血清CD3+CD4+T细胞计数与PaO
