Systemic Lupus Erythematosus (SLE)-02
Murwere mukadzi ane makore makumi maviri okuberekwa ane chirwere chakanyanya uye chiri kukurumidza kufambira mberi systemic lupus erythematosus (SLE). Zvisinei nekurapwa nehydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, uye belimumab, kushanda kweitsvo yake kwakadzikira mukati memwedzi mishanu, zvichikonzera nephritis yakaoma ine proteinuria (24-awa creatinine kukosha inosvika 10,717 mg/g) uye microscopic hematuria. Mumavhiki mana akatevera, creatinine level yake yakawedzera kusvika 1.69 mg/dl (yakajairika range 0.41 ~ 0.81 mg/dl), ichiperekedzwa ne hyperphosphatemia uye renal tubular acidosis. A renal biopsy yakaratidza danho rechina lupus nephritis. Iyo yakagadziridzwa NIH chiitiko index yaive 15 (yakanyanya 24), uye yakagadziridzwa NIH chronicity index yaive 1 (yakanyanya 12). Murwere akange adzikira mazinga ekuwedzera uye akawanda autoantibodies mumuviri wake, akadai seantinuclear antibodies, anti-double-stranded DNA, anti-nucleosome, uye anti-histone antibodies.
Mushure memwedzi mipfumbamwe, creatinine yemurwere yakakwira kusvika pa4.86 mg/dl, izvo zvaida dialysis uye kurapwa kweantihypertensive. Mhedzisiro yerabhoritari yakaratidza SLE Disease Activity Index (SLEDAI) mamakisi makumi maviri nematatu, zvichiratidza mamiriro akaoma kwazvo. Nekuda kweizvozvo, murwere akawana kurapwa kweCAR-T. Kurapa kwacho kwaiva seizvi:
- Vhiki imwe mushure meCAR-T cell infusion, nguva dzepakati pe dialysis sessions dzakawedzera.
Mwedzi mitatu mushure mekuiswa, creatinine level yakaderera kusvika 1.2 mg/dl, uye inofungidzirwa glomerular filtration rate (eGFR) yakawedzera kubva pashoma ye8 ml/min/1.73m² kusvika 24 ml/min/1.73m², zvichiratidza danho re3b. chirwere cheitsvo chisingaperi. Mishonga inorwisa BP yakaderedzwawo.
- Mushure memwedzi minomwe, zviratidzo zvemurwere zveArthritis zvakapera, kubatanidza zvinhu C3 neC4 zvakadzokera kune zvakajairika mukati memavhiki matanhatu, uye antinuclear antibodies, anti-dsDNA, uye mamwe autoantibodies akanyangarika. Kushanda kwetsvo yemurwere kwakavandudzika zvakanyanya, ne24-awa proteinuria ichidzika kusvika 3400 mg, kunyangwe yakaramba yakasimudzwa pakutevera kwekupedzisira, zvichiratidza kumwe kukuvadzwa kweglomerular kusingadzoreki. Iyo plasma albumin concentration yaive yakajairika, isina edema; Kuongorora weti hakuna kuratidza zviratidzo zvenephritis, uye pakanga pasina hematuria kana masero matsvuku eropa. Murwere zvino atangazve hupenyu hwemazuva ese.
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