Systemic Lupus Erythematosus (SLE)-02

Wodwalayo ndi wamkazi wazaka 20 yemwe ali ndi vuto lalikulu komanso lomwe likupita patsogolo mwachangu la systemic lupus erythematosus (SLE). Ngakhale adalandira chithandizo ndi hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, ndi belimumab, aimpso yake imawonongeka mkati mwa miyezi isanu, zomwe zidapangitsa nephritis yoopsa yokhala ndi proteinuria (mtengo wa maola 24 wa creatinine kufika 10,717 mg/g) ndi hematuria yaying'ono. M'milungu inayi yotsatira, mlingo wake wa creatinine udakwera kufika pa 1.69 mg/dl (osiyanasiyana 0.41 ~ 0.81 mg/dl), limodzi ndi hyperphosphatemia ndi aimpso tubular acidosis. A aimpso biopsy anasonyeza siteji 4 lupus nephritis. Mndandanda wosinthidwa wa NIH unali 15 (maximum 24), ndipo ndondomeko yosinthidwa ya NIH inali 1 (maximum 12). Wodwalayo anali atachepetsa kuchuluka kwa othandizira komanso ma autoantibodies angapo m'thupi mwake, monga ma antibodies a antinuclear, DNA yolimbana ndi mizere iwiri, anti-nucleosome, ndi anti-histone antibodies.

Patatha miyezi isanu ndi inayi, mlingo wa creatinine wa wodwalayo unakwera kufika pa 4.86 mg/dl, zomwe zimafunika dialysis ndi mankhwala ochepetsa kuthamanga kwa magazi. Zotsatira za labotale zidawonetsa chiwerengero cha SLE Disease Activity Index (SLEDAI) cha 23, chosonyeza vuto lalikulu kwambiri. Chifukwa chake, wodwalayo adalandira chithandizo cha CAR-T. Njira ya chithandizo inali motere:

- Patangotha ​​​​sabata imodzi kulowetsedwa kwa cell ya CAR-T, mipata pakati pa magawo a dialysis idakula.

- Miyezi itatu atatha kulowetsedwa, mlingo wa creatinine unatsika kufika 1.2 mg/dl, ndipo mlingo wa kusefera kwa glomerular (eGFR) udakwera kuchoka pa 8 ml/min/1.73m² kufika 24 ml/m/1.73m², kusonyeza gawo la 3b matenda a impso. Mankhwala a antihypertensive adachepetsedwanso.

- Pambuyo pa miyezi isanu ndi iwiri, zizindikiro za nyamakazi za wodwalayo zinachepa, zowonjezera zowonjezera C3 ndi C4 zinabwerera mwakale mkati mwa masabata asanu ndi limodzi, ndipo ma antibodies a anti-nuclear, anti-dsDNA, ndi ma autoantibodies ena adatha. Kugwira ntchito kwa aimpso kwa wodwalayo kunayenda bwino kwambiri, pomwe proteinuria ya maola 24 idatsika mpaka 3400 mg, ngakhale idakhalabe yokwera pamapeto omaliza, zomwe zikuwonetsa kuwonongeka kwa glomerular kosasinthika. The plasma albumin ndende anali wabwinobwino, popanda edema; kusanthula mkodzo sanawonetse zizindikiro za nephritis, ndipo panalibe hematuria kapena maselo ofiira a magazi. Wodwalayo tsopano wayambiranso kukhala ndi moyo wabwinobwino.