2026 年第 3 期 第 21 卷

免疫性血小板减少症中血小板输注无效的免疫机制与临床管理策略研究

Research on immune mechanisms and clinical management strategies of platelet transfusion refractoriness in immune thrombocytopenia

作者：江雯雯1冯琪2鲍计章1

英文作者：Jiang Wenwen1 Feng Qi2 Bao Jizhang1

单位：1上海中医药大学附属市中医医院血液病科，上海200071；2上海中医药大学附属市中医医院检验科，上海200071

英文单位：1Department of Hematology Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai 200071 China; 2Department of Laboratory Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai 200071 China

关键词：免疫性血小板减少症；血小板输注无效；免疫分型；治疗策略

英文关键词：Immunethrombocytopenia;Platelettransfusionrefractoriness;Immunetyping;Therapeuticstrategy

• 摘要：

• 免疫性血小板减少症（ITP）是一种以血小板减少和出血倾向为特征的自身免疫性疾病，临床上对其血小板输注无效（PTR）是影响治疗效果的重要因素。本文旨在探讨ITP中PTR的免疫机制及其对临床管理的影响，重点分析抗体介导型和T细胞介导型PTR的不同机制。通过文献回顾，我们发现抗体介导型PTR主要由特异性抗体，如人类白细胞抗原和抗血小板膜糖蛋白Ⅱb/Ⅲa抗体引发，这些抗体通过补体激活和巨噬细胞清除输注血小板，显著增加出血风险；而T细胞介导型PTR则涉及CD+8T细胞的异常激活，抑制巨核细胞生成，导致慢性病程。基于这些机制，本文提出“机制导向的分型诊疗”策略，建议针对抗体介导型采取人类白细胞抗原匹配输注和免疫球蛋白联合治疗，而T细胞介导型则需依赖血小板生成素受体激动剂和免疫抑制剂的联合干预。未来的研究应聚焦于动态免疫监测技术的应用、双功能生物制剂的开发及个体化精准医学的实现，以期显著改善ITP患者的治疗效果和生活质量。本研究为ITP的个体化治疗提供了重要的理论基础和实践指导。

• Immune thrombocytopenia (ITP) is an autoimmune disease characterized by thrombocytopenia and bleeding tendency, and clinical platelet transfusion refractoriness (PTR) is a crucial factor affecting therapeutic efficacy. This study aimed to explore the immune mechanisms of PTR in ITP and their impacts on clinical management, with a focus on analyzing the distinct mechanisms of antibody-mediated and T cell-mediated PTR. Through literature review, we found that antibody-mediated PTR is mainly induced by specific antibodies such as human leukocyte antigen and anti-platelet membrane glycoprotein Ⅱb/Ⅲa antibodies. These antibodies clear transfused platelets via complement activation and phagocytosis by macrophages, significantly increasing the risk of bleeding. In contrast, T cell-mediated PTR involves the abnormal activation of CD+8 T cells, which inhibits megakaryocytopoiesis and leads to a chronic disease course. Based on these mechanisms, this study proposed a strategy of "mechanism-oriented classified diagnosis and treatment". It is suggested that human leukocyte antigen-matched transfusion combined with immunoglobulin therapy be adopted for antibody-mediated PTR, while the combined intervention of thrombopoietin receptor agonists and immunosuppressants be applied for T cell-mediated PTR. Future research should focus on the application of dynamic immune monitoring technologies, the development of bifunctional biological agents and the realization of individualized precision medicine, so as to significantly improve the therapeutic efficacy and quality of life of ITP patients. This study provides an important theoretical basis and practical guidance for the individualized treatment of ITP.