Lupus Erythematosus Pūnaha (SLE)-02

He wahine 20-tau te pakeke o te tūroro, he nui, he tere hoki te whanaketanga o te mate lupus erythematosus pūnaha (SLE). Ahakoa te rongoā ki te hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, me te belimumab, i heke te mahi a ōna whatukuhu i roto i ngā marama e rima, ā, ka puta he nephritis kino me te proteinuria (ko te uara creatinine 24-hāora e eke ana ki te 10,717 mg/g) me te hematuria microscopic. I roto i ngā wiki e whā i muri mai, ka piki ake tana taumata creatinine ki te 1.69 mg/dl (te awhe noa 0.41~0.81 mg/dl), me te hyperphosphatemia me te waikawa ngongo whatukuhu. I whakaatuhia e te koiora whatukuhu te taumata 4 o te lupus nephritis. Ko te tohu ngohe NIH whakarerekētia he 15 (te mōrahi 24), ā, ko te tohu mau tonu NIH whakarerekētia he 1 (te mōrahi 12). He iti iho ngā taumata tāpiringa o te tūroro me ngā autoantibodies maha i roto i tōna tinana, pērā i ngā antibodies antinuclear, te DNA anti-double-stranded, te anti-nucleosome, me ngā antibodies anti-histone.

I muri i ngā marama e iwa, ka piki te taumata creatinine o te tūroro ki te 4.86 mg/dl, ā, me tango he dialysis me te rongoā ārai toto. I whakaatuhia e ngā hua taiwhanga he kaute SLE Disease Activity Index (SLEDAI) he 23, e tohu ana i tētahi mate tino kino. Nō reira, i whiwhi te tūroro i te rongoā CAR-T. Ko te tukanga maimoatanga i penei:

- Kotahi wiki i muri i te werohanga pūtau CAR-T, ka piki ake ngā wā i waenga i ngā wā tātaritanga.

- I roto i ngā marama e toru i muri i te werohanga, i heke te taumata creatinine ki te 1.2 mg/dl, ā, i piki ake te tere tātari glomerular (eGFR) mai i te iti rawa o te 8 ml/min/1.73m² ki te 24 ml/min/1.73m², e tohu ana i te mate tākihi mau tonu o te wahanga 3b. I whakaitihia hoki ngā rongoā ārai toto toto tiketike.

- I muri i ngā marama e whitu, ka memeha haere ngā tohumate o te mate rumatiki o te tūroro, ka hoki anō ngā āhuatanga tāpiri C3 me C4 ki te āhua noa i roto i ngā wiki e ono, ā, ka ngaro atu ngā paturopi anti-nuklear, te anti-dsDNA, me ētahi atu paturopi autoantibodies. I tino pai ake te mahi a te tākihi o te tūroro, me te hekenga o te proteinuria 24-hāora ki te 3400 mg, ahakoa i noho teitei tonu i te arotakenga whakamutunga, e tohu ana i ētahi kino kore e taea te whakatika i roto i te glomerular. He noa te kukū o te albumin plasma, kāore he pupuhi; kāore i whakaatuhia e te tātaritanga mimi he tohu o te nephritis, ā, kāore he hematuria, he toto whero rānei. Kua hoki anō te tūroro ki te oranga noa.