Systemic Lupus Erythematosus (SLE)-02

Murwere uyu mukadzi ane makore makumi maviri ekuberekwa ane chirwere chesystemic lupus erythematosus (SLE) chakakomba uye chiri kukurumidza kukura. Pasinei nekurapwa nehydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, uye belimumab, kushanda kweitsvo dzake kwakaderera mukati memwedzi mishanu, zvichikonzera nephritis yakakomba neproteinuria (24-hour creatinine value inosvika 10,717 mg/g) uye microscopic hematuria. Mumavhiki mana akatevera, huwandu hwake hwecreatinine hwakawedzera kusvika 1.69 mg/dl (yakajairika 0.41~0.81 mg/dl), pamwe chete nehyperphosphatemia uye renal tubular acidosis. Kuongororwa kweitsvo kwakaratidza danho rechina re lupus nephritis. Chiratidzo cheNIH activity index chakagadziridzwa chaive 15 (chakanyanya 24), uye chiratidzo cheNIH chronicity index chakagadziridzwa chaive 1 (chakanyanya 12). Murwere wacho akanga adzikira huwandu hwemuviri wake uye ma antibodies akawanda mumuviri wake, akadai se antinuclear antibodies, anti-double-stranded DNA, anti-nucleosome, uye anti-histone antibodies.

Mwedzi mipfumbamwe gare gare, huwandu hwe creatinine hwemurwere hwakawedzera kusvika pa4.86 mg/dl, zvichireva kuti aida dialysis uye antihypertensive therapy. Zvakabuda murabhoritari zvakaratidza SLE Disease Activity Index (SLEDAI) score ye23, zvichiratidza kuti chirwere chacho chakanyanya kuipa. Nekuda kweizvozvo, murwere akarapwa neCAR-T therapy. Maitiro ekurapwa aive akadai:

- Vhiki imwe mushure mekuiswa kweCAR-T cell, nguva pakati penguva dze dialysis dzakawedzera.

- Mwedzi mitatu mushure mekupinzwa mushonga, huwandu hwe creatinine hwakaderera kusvika pa 1.2 mg/dl, uye chiyero chekupfapfaidza che glomerular (eGFR) chakawedzera kubva pa 8 ml/min/1.73m² kusvika pa 24 ml/min/1.73m², zvichiratidza chirwere cheitsvo chedanho rechitatu. Mishonga yekuderedza BP yakaderedzwawo.

- Mushure memwedzi minomwe, zviratidzo zvearthritis zvemurwere zvakaderera, zvinhu zvinosimbisa C3 neC4 zvakadzokera kune zvakajairika mukati memavhiki matanhatu, uye ma antibodies e antinuclear, anti-dsDNA, nezvimwe zvirwere zve autoantibodies zvakanyangarika. Kushanda kweitsvo kwemurwere kwakavandudzika zvakanyanya, neproteinuria yemaawa makumi maviri nemana ichiderera kusvika pa3400 mg, kunyange zvazvo yakaramba yakakwira pakuongororwa kwekupedzisira, zvichiratidza kukuvara kweglomerular kusingadzoreki. Kuwanda kwe albumin muplasma kwaive kwakajairika, pasina kuzvimba; kuongororwa kweweti hakuna kuratidza zviratidzo zve nephritis, uye pakanga pasina hematuria kana masero matsvuku eropa. Murwere iye zvino adzokerazve kuhupenyu hwakajairika.