Lupus Erythematosus (SLE)-02

Tus neeg mob yog ib tug poj niam muaj hnub nyoog 20 xyoo uas muaj mob hnyav thiab nce zuj zus sai ntawm cov kab mob lupus erythematosus (SLE). Txawm hais tias kev kho mob nrog hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, thiab belimumab, nws lub raum ua haujlwm tsis zoo nyob rau hauv tsib lub hlis, ua rau mob nephritis nrog proteinuria (24-teev creatinine tus nqi nce mus txog 10,717 mg / g) thiab microscopic hematuria. Hauv plaub lub lis piam tom ntej, nws qib creatinine nce mus rau 1.69 mg / dl (ib txwm muaj 0.41 ~ 0.81 mg / dl), nrog rau hyperphosphatemia thiab raum tubular acidosis. Lub raum biopsy qhia txog theem 4 lupus nephritis. Qhov hloov kho NIH qhov Performance index yog 15 (siab tshaj 24), thiab qhov hloov kho NIH chronicity index yog 1 (ntau tshaj 12). Tus neeg mob tau txo qis cov qib ntxiv thiab ntau yam autoantibodies hauv nws lub cev, xws li cov tshuaj tiv thaiv antinuclear, anti-ob-stranded DNA, anti-nucleosome, thiab anti-histone antibodies.

Cuaj hlis tom qab, tus neeg mob lub creatinine theem tau nce mus rau 4.86 mg / dl, yuav tsum tau dialysis thiab antihypertensive therapy. Cov txiaj ntsig hauv chav kuaj pom pom SLE Disease Activity Index (SLEDAI) qhab nia ntawm 23, qhia tias muaj mob hnyav heev. Yog li ntawd, tus neeg mob tau txais kev kho mob CAR-T. Txoj kev kho mob tau raws li nram no:

- Ib lub lis piam tom qab CAR-T cell infusion, lub sijhawm nruab nrab ntawm kev lim ntshav nce ntxiv.

- Peb lub hlis tom qab txhaj tshuaj, qib creatinine poob mus rau 1.2 mg / dl, thiab kwv yees glomerular filtration rate (eGFR) nce los ntawm qhov tsawg kawg nkaus ntawm 8 ml / min / 1.73m² mus rau 24 ml / min / 1.73m², qhia txog theem 3b. mob raum mob. Cov tshuaj antihypertensive kuj raug txo.

- Tom qab xya lub hlis, tus neeg mob cov tsos mob ntawm kev mob caj dab tau txo qis, ntxiv rau C3 thiab C4 rov zoo li qub nyob rau hauv rau lub lis piam, thiab cov tshuaj tua kab mob antinuclear, anti-dsDNA, thiab lwm yam autoantibodies ploj mus. Tus neeg mob lub raum ua haujlwm tau zoo dua qub, nrog rau 24-teev cov proteinuria tsawg zuj zus mus rau 3400 mg, txawm hais tias nws tseem nce siab ntawm qhov kev soj ntsuam zaum kawg, qhia txog qee qhov kev puas tsuaj glomerular. Lub plasma albumin concentration yog qhov qub, tsis muaj edema; Kev tsom xam cov zis tsis pom muaj cov tsos mob ntawm nephritis, thiab tsis muaj hematuria lossis ntshav liab casts. Tam sim no tus neeg mob tau rov ua lub neej zoo li qub.