Erythematosus nke Sistemụ Lupus (SLE)-02

Onye ọrịa ahụ bụ nwanyị dị afọ iri abụọ nwere ọrịa lupus erythematosus nke na-akawanye njọ ma na-aga n'ihu ngwa ngwa (SLE). N'agbanyeghị ọgwụgwọ hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, na belimumab, ọrụ akụrụ ya dara ada n'ime ọnwa ise, na-ebute nnukwu nephritis na proteinuria (uru creatinine awa 24 ruru 10,717 mg/g) na obere hematuria. N'ime izu anọ sochirinụ, ọkwa creatinine ya mụbara ruo 1.69 mg/dl (oke nkịtị 0.41 ~ 0.81 mg/dl), yana hyperphosphatemia na renal tubular acidosis. Nnyocha biopsy akụrụ gosiri ọkwa nke anọ nke lupus nephritis. Ndepụta ọrụ NIH emezigharịrị bụ 15 (oke kachasị 24), na NIH chronicity index emezigharịrị bụ 1 (oke kachasị 12). Onye ọrịa ahụ nwere mbelata ọkwa complement na ọtụtụ autoantibodies n'ahụ ya, dị ka antinuclear antibodies, anti-double-stranded DNA, anti-nucleosome, na anti-histone antibodies.

Mgbe ọnwa itoolu gachara, ọkwa creatinine nke onye ọrịa ahụ rịrị elu ruo 4.86 mg/dl, nke chọrọ dialysis na ọgwụgwọ mgbochi ọbara mgbali elu. Nsonaazụ ụlọ nyocha gosiri akara SLE Disease Activity Index (SLEDAI) nke 23, na-egosi ọnọdụ dị oke njọ. N'ihi ya, onye ọrịa ahụ natara ọgwụgwọ CAR-T. Usoro ọgwụgwọ ahụ dị ka ndị a:

- Otu izu mgbe etinyere mkpụrụ ndụ CAR-T, oge dị n'etiti oge ọgwụgwọ dialysis mụbara.

- Ọnwa atọ mgbe a mịnyechara ya, ọkwa creatinine ahụ dara ruo 1.2 mg/dl, a na-atụkwa anya na ọnụego nzacha glomerular (eGFR) mụbara site na opekata mpe 8 ml/min/1.73m² ruo 24 ml/min/1.73m², nke na-egosi ọrịa akụrụ na-adịghị ala ala nke ọkwa 3b. E belatakwara ọgwụ ndị na-egbochi ọbara mgbali elu.

- Mgbe ọnwa asaa gachara, ihe mgbaàmà nke ọrịa ogbu na nkwonkwo nke onye ọrịa ahụ belatara, ihe mgbakwunye C3 na C4 laghachiri n'ọnọdụ kwesịrị ekwesị n'ime izu isii, ọgwụ mgbochi antinuclear, anti-dsDNA, na ọgwụ mgbochi autoantibodies ndị ọzọ kwụsịrị. Ọrụ akụrụ nke onye ọrịa ahụ ka mma nke ukwuu, ebe proteinuria awa 24 na-ebelata ruo 3400 mg, ọ bụ ezie na ọ nọgidere na-abawanye elu na nleba anya ikpeazụ, na-egosi mmebi glomerular na-enweghị mgbagha. Ọnụọgụ albumin dị na plasma bụ ihe nkịtị, enweghịkwa edema; nyocha mmamịrị egosighi ihe ịrịba ama nke nephritis, enweghịkwa hematuria ma ọ bụ mkpụrụ ndụ ọbara uhie. Onye ọrịa ahụ amaliteghachila ndụ nkịtị ugbu a.