Systemic Lupus Erythematosus (SLE)-02

Mokuli ke mosali ea lilemo li 20 ea nang le systemic lupus erythematosus (SLE) e matla le e ntseng e tsoela pele ka potlako. Leha a ne a phekoloa ka hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, le belimumab, ts'ebetso ea hae ea renal e ile ea mpefala nakong ea likhoeli tse hlano, e leng se ileng sa lebisa ho nephritis e matla e nang le proteinuria (boleng ba creatinine ea lihora tse 24 bo fihlang ho 10,717 mg/g) le microscopic hematuria. Libekeng tse 'nè tse latelang, boemo ba hae ba creatinine bo ile ba eketseha ho ea ho 1.69 mg/dl (lebaka le tloaelehileng la 0.41~0.81 mg/dl), le tsamaea le hyperphosphatemia le renal tubular acidosis. Tlhahlobo ea renal biopsy e bontšitse mothati oa 4 lupus nephritis. Lenane la ts'ebetso ea NIH e fetotsoeng e ne e le 15 (boholo ba 24), 'me index ea NIH e fetotsoeng e ne e le 1 (boholo ba 12). Mokuli o ne a fokotsehile maemong a tlatsetso le li-autoantibodies tse ngata 'meleng oa hae, joalo ka li-antibodies tsa antinuclear, DNA e khahlanong le li-double-stranded, anti-nucleosome, le li-anti-histone antibodies.

Likhoeli tse robong hamorao, tekanyo ea creatinine ea mokuli e ile ea nyolohela ho 4.86 mg/dl, e neng e hloka dialysis le phekolo ea antihypertensive. Liphetho tsa laboratori li bontšitse palo ea SLE Disease Activity Index (SLEDAI) ea 23, e bontšang boemo bo boima haholo. Ka lebaka leo, mokuli o ile a fuoa phekolo ea CAR-T. Mokhoa oa phekolo o ne o le tjena:

- Beke e le 'ngoe ka mor'a ho kenngoa ha sele ea CAR-T, linako tse pakeng tsa li-dialysis li ile tsa eketseha.

- Likhoeli tse tharo ka mor'a ho tšeloa, boemo ba creatinine bo theohetse ho 1.2 mg/dl, 'me tekanyo e hakantsoeng ea glomerular filtration (eGFR) e eketsehile ho tloha bonyane ba 8ml/min/1.73m² ho ea ho 24 ml/min/1.73m², e bontšang mohato oa 3b lefu le sa foleng la liphio. Meriana ea antihypertensive le eona e ile ea fokotsoa.

- Ka mor'a likhoeli tse supileng, matšoao a ramatiki a mokuli a ile a kokobela, lintlha tse tlatselletsang C3 le C4 li ile tsa khutlela ho tloaelehileng nakong ea libeke tse tšeletseng, 'me li-antibodies tsa antinuclear, anti-dsDNA, le li-autoantibodies tse ling li ile tsa nyamela. Ts'ebetso ea renal ea mokuli e ile ea ntlafala haholo, ha protheine ea lihora tse 24 e theohetse ho 3400 mg, le hoja e ile ea lula e phahame ka mor'a tlhahlobo ea ho qetela, e fana ka maikutlo a hore ho na le tšenyo e ke keng ea etsolloa ea glomerular. Khatello ea albin ea plasma e ne e tloaelehile, e se na edema; tlhahlobo ea moroto ha ea ka ea bontša matšoao a nephritis, 'me ho ne ho se na hematuria kapa lisele tse khubelu tsa mali. Hona joale mokuli o se a qalelletse bophelo bo tloaelehileng.