Systemic Lupus Erythematosus (SLE)-02

Wodwalayo ndi mkazi wazaka 20 yemwe ali ndi matenda oopsa komanso ofulumira a lupus erythematosus (SLE). Ngakhale kuti adalandira chithandizo cha hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, ndi belimumab, ntchito yake ya impso inachepa mkati mwa miyezi isanu, zomwe zinapangitsa kuti adwale matenda a nephritis aakulu ndi proteinuria (creatinine value ya maola 24 kufika pa 10,717 mg/g) ndi microscopic hematuria. M'masabata anayi otsatira, kuchuluka kwa creatinine kwake kunakwera kufika pa 1.69 mg/dl (nthawi yabwinobwino kuyambira 0.41 mpaka 0.81 mg/dl), limodzi ndi hyperphosphatemia ndi renal tubular acidosis. Kuyezetsa impso kunasonyeza kuti ali ndi lupus nephritis ya gawo lachinayi. Chizindikiro cha zochita za NIH chosinthidwa chinali 15 (nthawi yoposa 24), ndipo chizindikiro cha NIH chronicity chosinthidwa chinali 1 (nthawi yoposa 12). Wodwalayo anali ndi kuchuluka kochepa kwa ma antibodies m'thupi lake komanso ma antibodies ambiri m'thupi lake, monga ma antibodies a antinuclear, DNA yotsutsana ndi ma stranded awiri, ma antibodies a antinucleosome, ndi ma antibodies a anti-histone.

Patatha miyezi isanu ndi inayi, kuchuluka kwa creatinine kwa wodwalayo kunakwera kufika pa 4.86 mg/dl, zomwe zinafunika dialysis ndi mankhwala ochepetsa kuthamanga kwa magazi. Zotsatira za labotale zinasonyeza kuti SLE Disease Activity Index (SLEDAI) inali 23, zomwe zinasonyeza kuti anali ndi vuto lalikulu kwambiri. Chifukwa chake, wodwalayo analandira chithandizo cha CAR-T. Njira yochizira inali motere:

- Sabata imodzi pambuyo pa kulowetsedwa kwa maselo a CAR-T, nthawi yopuma pakati pa nthawi ya dialysis inawonjezeka.

- Patatha miyezi itatu kuchokera pamene anapatsidwa mankhwala, kuchuluka kwa creatinine kunatsika kufika pa 1.2 mg/dl, ndipo chiŵerengero cha kusefa kwa glomerular (eGFR) chinakwera kuchoka pa 8 ml/min/1.73m² kufika pa 24 ml/min/1.73m², zomwe zikusonyeza matenda aakulu a impso a siteji ya 3b. Mankhwala ochepetsa kuthamanga kwa magazi nawonso anachepetsedwa.

- Patatha miyezi isanu ndi iwiri, zizindikiro za nyamakazi za wodwalayo zinachepa, zinthu zowonjezera C3 ndi C4 zinabwerera mwakale mkati mwa milungu isanu ndi umodzi, ndipo ma antibodies a antinuclear, anti-dsDNA, ndi ma autoantibodies ena anatha. Ntchito ya impso ya wodwalayo inasintha kwambiri, ndipo proteinuria ya maola 24 inatsika kufika pa 3400 mg, ngakhale kuti inakhalabe yokwera pa nthawi yomaliza, zomwe zikusonyeza kuwonongeka kosatha kwa glomerular. Kuchuluka kwa albumin m'magazi kunali kwabwinobwino, popanda kutupa; kusanthula mkodzo sikunawonetse zizindikiro za nephritis, ndipo panalibe hematuria kapena maselo ofiira a magazi. Wodwalayo tsopano wayambiranso moyo wabwinobwino.