Usoro Lupus Erythematosus (SLE) -02

Onye ọrịa ahụ bụ nwanyị dị afọ 20 nwere nnukwu lupus erythematosus systemic (SLE). N'agbanyeghị ọgwụgwọ ya na hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, na belimumab, ọrụ akụrụ ya dara njọ n'ime ọnwa ise, na-eduga na nephritis siri ike na proteinuria (uru creatinine awa 24 ruru 10,717 mg / g) na hematuria microscopic. N'ime izu anọ sochirinụ, ọkwa nke creatinine mụbara ruo 1.69 mg/dl (oke 0.41 ~ 0.81 mg / dl), yana hyperphosphatemia na renal tubular acidosis. Biopsy gbasara akụrụ gosipụtara ogbo 4 lupus nephritis. Ntụkọ ọrụ NIH gbanwere bụ 15 (kachasị 24), na NIH chronicity index gbanwere bụ 1 (kachasị 12). Onye ọrịa ahụ belatara ọkwa nkwado yana ọtụtụ autoantibodies n'ime ahụ ya, dị ka ọgwụ mgbochi nuklia, mgbochi DNA nke nwere eriri abụọ, mgbochi nucleosome, na mgbochi hisstone.

Ọnwa itoolu ka e mesịrị, ọkwa creatinine nke onye ọrịa bilitere ruo 4.86 mg/dl, chọrọ dialysis na ọgwụgwọ antihypertensive. Nsonaazụ ụlọ nyocha gosiri akara SLE Disease Activity Index (SLEDAI) nke 23, na-egosi ọnọdụ siri ike. N'ihi ya, onye ọrịa ahụ nwetara ọgwụgwọ CAR-T. Usoro ọgwụgwọ ahụ bụ nke a:

- Otu izu mgbe infusion cell CAR-T gachara, oge dị n'etiti oge dialysis mụbara.

- Ọnwa atọ ka mmịnye gachara, ọkwa creatinine gbadara ruo 1.2 mg/dl, yana atụmatụ nzacha glomerular filtration (eGFR) mụbara site na opekempe 8 ml/min/1.73m² ruo 24 ml/min/1.73m², na-egosi ọkwa 3b. ọrịa akụrụ na-adịghị ala ala. E belatara ọgwụ mgbochi hypertensive.

- Mgbe ọnwa asaa gasịrị, mgbaàmà ọrịa ogbu na nkwonkwo nke onye ọrịa kwụsịrị, ihe mgbakwunye C3 na C4 laghachiri na nkịtị n'ime izu isii, na antinuclear antibodies, anti-dsDNA, na autoantibodies ndị ọzọ na-apụ n'anya. Ọrụ gbasara akụrụ onye ọrịa na-abawanye nke ọma, na proteinuria nke awa 24 na-agbada ruo 3400 mg, ọ bụ ezie na ọ nọgidere na-ebuli elu na nsonye ikpeazụ, na-atụ aro ụfọdụ mmebi glomerular na-enweghị ike ịgbanwe. Ntinye uche nke albumin plasma dị mma, na-enweghị edema; Nnyocha mmamịrị egosighi akara nephritis, ọ nweghịkwa hematuria ma ọ bụ nkedo ọbara uhie. Onye ọrịa ahụ amaliteghachila ndụ nkịtị ugbu a.