ʻO ka Lupus Erythematosus Pūnaehana (SLE)-02

He wahine 20 makahiki ka mea maʻi me ka maʻi lupus erythematosus systemic koʻikoʻi a holomua wikiwiki (SLE). ʻOiai ua mālama ʻia me ka hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, a me belimumab, ua hōʻino ʻia kāna hana renal i loko o ʻelima mau mahina, e alakaʻi ana i ka nephritis koʻikoʻi me ka proteinuria (ʻo ka waiwai creatinine 24-hola e hiki ana i ka 10,717 mg/g) a me ka hematuria microscopic. I loko o nā pule ʻehā e hiki mai ana, ua piʻi kona pae creatinine i 1.69 mg/dl (maʻamau 0.41 ~ 0.81 mg/dl), me ka hyperphosphatemia a me ka renal tubular acidosis. Ua hōʻike kahi biopsy renal i ka pae 4 lupus nephritis. ʻO ka helu kuhikuhi hana NIH i hoʻololi ʻia he 15 (maximum 24), a ʻo ka helu kuhikuhi NIH chronicity i hoʻololi ʻia he 1 (maximum 12). Ua emi nā pae complement o ka mea maʻi a me nā autoantibodies he nui i loko o kona kino, e like me nā antibodies antinuclear, anti-double-stranded DNA, anti-nucleosome, a me nā anti-histone antibodies.

ʻEiwa mahina ma hope mai, ua piʻi ka pae creatinine o ka mea maʻi i 4.86 mg/dl, e koi ana i ka dialysis a me ka lāʻau antihypertensive. Ua hōʻike nā hopena o ka hale hana i kahi helu SLE Disease Activity Index (SLEDAI) o 23, e hōʻike ana i kahi maʻi koʻikoʻi loa. No laila, ua hana ʻia ka lāʻau CAR-T i ka mea maʻi. Penei ke kaʻina hana lapaʻau:

- Hoʻokahi pule ma hope o ka hoʻokomo ʻia ʻana o nā pūnaewele CAR-T, ua hoʻonui ʻia nā wā ma waena o nā kau dialysis.

- ʻEkolu mahina ma hope o ka hoʻokomo ʻana, ua emi ka pae creatinine i 1.2 mg/dl, a ua piʻi ka helu kānana glomerular i manaʻo ʻia (eGFR) mai ka liʻiliʻi o 8 ml/min/1.73m² a i 24 ml/min/1.73m², e hōʻike ana i ka maʻi puʻupaʻa mau loa o ke kahua 3b. Ua hoʻemi ʻia hoʻi nā lāʻau antihypertensive.

- Ma hope o ʻehiku mahina, ua emi iho nā hōʻailona o ka maʻi arthritis, ua hoʻi hou nā kumu complement C3 a me C4 i ka maʻamau i loko o ʻeono pule, a ua nalowale nā ​​​​antibodies antinuclear, anti-dsDNA, a me nā autoantibodies ʻē aʻe. Ua hoʻomaikaʻi nui ʻia ka hana renal o ka mea maʻi, me ka emi ʻana o ka proteinuria 24-hola i 3400 mg, ʻoiai ua noho kiʻekiʻe ia i ka hahai hope loa, e hōʻike ana i kekahi mau hōʻino glomerular irreversible. Ua maʻamau ka nui o ka plasma albumin, me ka ʻole o ka edema; ʻaʻole i hōʻike ka loiloi mimi i nā hōʻailona o ka nephritis, a ʻaʻohe hematuria a i ʻole nā ​​​​​​mea hoʻolei koko ʻulaʻula. Ua hoʻi hou ka mea maʻi i kahi ola maʻamau.