Chen Yangchun, Shi Yingying, Sun Yuechi, Peng Yun, Shi Guixiu, Liu Yuan, Chen Shiju
Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.
Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, China.
Immun Inflamm Dis. 2025 Jul;13(7):e70236. doi: 10.1002/iid3.70236.
Corticosteroid-resistant secondary immune thrombocytopenia (ITP) is a challenging condition in clinical practice. This study aimed to explore the clinical and immunological characteristics of corticosteroid-resistant secondary ITP associated with connective tissue diseases (CTD-ITP).
We conducted a retrospective analysis of 201 CTD-ITP hospitalized patients between 2014 and 2022. Patients were categorized as corticosteroid-resistant or corticosteroid-sensitive, and their demographic, clinical, and immunological data were compared. Logistic regression analysis was employed to identify independent predictors of corticosteroid resistance.
Corticosteroid resistance was observed in 27.4% of patients. Compared with the corticosteroid-sensitive group, the corticosteroid-resistant group exhibited a higher percentage of CD3 T cell (71.38% vs. 64.70%, p = 0.004) and CD3CD8 T cell (38.55% vs. 28.95%, p = 0.003), but a lower percentage of CD19 B cell (13.70% vs. 22.45%, p = 0.001) in peripheral blood. No significant differences were found in other demographics, clinical features, or autoantibody profiles. The multivariable logistic regression analysis showed that higher percentage of CD3CD8 T cells (OR = 1.170, 95% CI: 1.014-1.350, p = 0.031) was an independent risk factor for corticosteroid resistance in CTD-ITP patients.
This study revealed the potential role of higher CD3CD8 T cells in corticosteroid resistance among CTD-ITP patients, and provided the potential biomarker for predicting corticosteroid therapy response.
皮质类固醇抵抗性继发性免疫性血小板减少症（ITP）在临床实践中是一种具有挑战性的病症。本研究旨在探讨与结缔组织病相关的皮质类固醇抵抗性继发性ITP（CTD-ITP）的临床和免疫学特征。
我们对2014年至2022年间住院的201例CTD-ITP患者进行了回顾性分析。将患者分为皮质类固醇抵抗组或皮质类固醇敏感组，并比较他们的人口统计学、临床和免疫学数据。采用逻辑回归分析来确定皮质类固醇抵抗的独立预测因素。
27.4%的患者存在皮质类固醇抵抗。与皮质类固醇敏感组相比，皮质类固醇抵抗组外周血中CD3 T细胞（71.38%对64.70%，p = 0.004）和CD3CD8 T细胞（38.55%对28.95%，p = 0.003）的百分比更高，但CD19 B细胞的百分比更低（13.70%对22.45%，p = 0.001）。在其他人口统计学、临床特征或自身抗体谱方面未发现显著差异。多变量逻辑回归分析显示，较高的CD3CD8 T细胞百分比（OR = 1.170，95%CI：1.014 - 1.350，p = 0.031）是CTD-ITP患者皮质类固醇抵抗的独立危险因素。
本研究揭示了较高的CD3CD8 T细胞在CTD-ITP患者皮质类固醇抵抗中的潜在作用，并为预测皮质类固醇治疗反应提供了潜在的生物标志物。
