Tsarin Lupus Erythematosus (SLE) -02

Mai haƙuri shine mace mai shekaru 20 mai tsanani kuma mai saurin ci gaba na lupus erythematosus (SLE). Duk da jiyya da hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, da belimumab, aikin renal nata ya lalace cikin watanni biyar, wanda ke haifar da nephritis mai tsanani tare da proteinuria (ƙimar creatinine na awa 24 wanda ya kai 10,717 mg / g) da hematuria microscopic. A cikin makonni hudu masu zuwa, matakin creatinine ya karu zuwa 1.69 mg/dl (na al'ada 0.41 ~ 0.81 mg/dl), tare da hyperphosphatemia da renal tubular acidosis. Wani biopsy na koda ya nuna mataki na 4 lupus nephritis. Ƙididdigar ayyukan NIH da aka gyara ita ce 15 (mafi girman 24), kuma gyare-gyaren NIH na yau da kullum shine 1 (mafi girman 12). Mai haƙuri ya rage matakan haɓakawa da yawa autoantibodies a cikin jikinta, irin su antinuclear antibodies, anti-double stranded DNA, anti-nucleosome, da anti-histone antibodies.

Bayan watanni tara, matakin creatinine na majiyyaci ya tashi zuwa 4.86 mg/dl, yana buƙatar dialysis da maganin hauhawar jini. Sakamakon dakin gwaje-gwaje ya nuna alamar Ayyukan Ayyukan Cutar SLE (SLEDAI) na 23, yana nuna yanayi mai tsanani. Sakamakon haka, majiyyacin ya sha maganin CAR-T. Tsarin magani ya kasance kamar haka:

- Mako guda bayan jiko tantanin halitta CAR-T, tazara tsakanin zaman dialysis ya karu.

- Watanni uku bayan jiko, matakin creatinine ya ragu zuwa 1.2 mg/dl, kuma ƙididdige ƙimar tacewar glomerular (eGFR) ya ƙaru daga mafi ƙarancin 8 ml/min/1.73m² zuwa 24 ml/min/1.73m², yana nuna mataki na 3b. na kullum ciwon koda. An kuma rage magungunan hana hawan jini.

- Bayan watanni bakwai, alamun cututtukan arthritis na majiyyaci sun ragu, abubuwan da suka dace da C3 da C4 sun dawo daidai a cikin makonni shida, kuma antinuclear antibodies, anti-dsDNA, da sauran autoantibodies bace. Ayyukan koda na mai haƙuri ya inganta sosai, tare da proteinuria na sa'o'i 24 yana raguwa zuwa 3400 MG, ko da yake ya kasance mai girma a biyo baya na ƙarshe, yana nuna wasu lalacewar glomerular da ba za a iya jurewa ba. Matsayin albumin na plasma ya kasance na al'ada, ba tare da edema ba; Binciken fitsari bai nuna alamun nephritis ba, kuma babu hematuria ko simintin jan jini. A yanzu majiyyaci ya koma rayuwa ta al'ada.