Systemic Lupus Erythematosus (SLE)-02

He wahine 20 makahiki ka mea ma'i me ka lupus erythematosus (SLE) ko'iko'i. ʻOiai ka mālama ʻana me ka hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, a me belimumab, ua emi kāna hana renal i loko o ʻelima mau mahina, e alakaʻi ana i ka nephritis koʻikoʻi me ka proteinuria (24-hola creatinine waiwai a hiki i 10,717 mg/g) a me ka microscopic hematuria. I loko o nā pule ʻehā e hiki mai ana, ua hoʻonui ʻia kona pae creatinine i 1.69 mg/dl (maʻamau maʻamau 0.41~0.81 mg/dl), hele pū me ka hyperphosphatemia a me ka renal tubular acidosis. Ua hōʻike ʻia kahi biopsy renal i ka pae 4 lupus nephritis. ʻO ka helu helu hana NIH i hoʻololi ʻia ʻo 15 (maximum 24), a ʻo ka NIH chronicity index i hoʻololi ʻia ʻo 1 (maximum 12). Ua hoʻemi ka mea maʻi i nā pae hoʻohui a me nā autoantibodies he nui i loko o kona kino, e like me nā antibodies antinuclear, anti-double-stranded DNA, anti-nucleosome, a me nā anti-histone antibodies.

ʻEiwa mahina ma hope mai, piʻi ka pae creatinine o ka mea maʻi i ka 4.86 mg/dl, e koi ana i ka dialysis a me ka lāʻau antihypertensive. Ua hōʻike ʻia nā hualoaʻa o ka Laboratory i kahi helu SLE Disease Activity Index (SLEDAI) o 23, e hōʻike ana i kahi maʻi koʻikoʻi loa. No laila, ua loaʻa ka mea maʻi i ka lāʻau CAR-T. ʻO ke kaʻina hana lapaʻau penei:

- Hoʻokahi pule ma hope o ka hoʻokomo ʻana o ka cell CAR-T, ua hoʻonui ʻia nā manawa ma waena o nā kau dialysis.

- ʻEkolu mahina ma hope o ka hoʻokomo ʻana, ua hoʻemi ʻia ka pae creatinine i 1.2 mg/dl, a ua hoʻonui ʻia ka helu kānana glomerular filtration (eGFR) mai ka liʻiliʻi o 8 ml/min/1.73m² a i 24 ml/min/1.73m², e hōʻike ana i ka pae 3b maʻi ʻaʻai mau. Ua hōʻemi pū ʻia nā lāʻau antihypertensive.

- Ma hope o ʻehiku mahina, ua emi nā hōʻailona o ka maʻi o ka maʻi, ua hoʻihoʻi nā mea hoʻohui C3 a me C4 i ka maʻamau i loko o ʻeono pule, a nalowale nā ​​​​antibodies antinuclear, anti-dsDNA, a me nā autoantibodies ʻē aʻe. Ua hoʻomaikaʻi maikaʻi ʻia ka hana renal o ka mea maʻi, me ka 24-hola proteinuria e emi ana i 3400 mg, ʻoiai ua hoʻokiʻekiʻe ʻia i ka hopena hope loa, e hōʻike ana i kahi pōʻino glomerular hiki ʻole ke hoʻololi. He mea maʻamau ka plasma albumin concentration, me ka edema ʻole; ʻAʻohe hōʻailona o ka nephritis, a ʻaʻohe hematuria a i ʻole ke koko ʻulaʻula. Ua hoʻomaka hou ka mea maʻi i kahi ola maʻamau.