I-Systemic Lupus Erythematosus (SLE)-02

Isigulana ngumfazi oneminyaka engama-20 ubudala one-systemic lupus erythematosus (SLE) enzima neyanda ngokukhawuleza. Nangona wayenyangwa nge-hydroxychloroquine sulfate, i-azathioprine, i-mycophenolate mofetil, kunye ne-belimumab, ukusebenza kwezintso kwakhe kuye konakala kwiinyanga ezintlanu, nto leyo eyakhokelela kwi-nephritis enzima ene-proteinuria (ixabiso le-creatinine leeyure ezingama-24 lifikelela kwi-10,717 mg/g) kunye ne-microscopic hematuria. Kwiiveki ezine ezalandelayo, inqanaba lakhe le-creatinine landa laya kwi-1.69 mg/dl (uluhlu oluqhelekileyo luyi-0.41 ~ 0.81 mg/dl), kunye ne-hyperphosphatemia kunye ne-renal tubular acidosis. I-renal biopsy yabonisa isigaba sesi-4 se-lupus nephritis. I-modified NIH activity index yayiyi-15 (ubuninzi yi-24), kwaye i-modified NIH chronicity index yayiyi-1 (ubuninzi yi-12). Isigulana sasinamanqanaba aphantsi okugcwalisa kunye nee-autoantibodies ezininzi emzimbeni waso, ezifana nee-antinuclear antibodies, i-anti-double-stranded DNA, i-anti-nucleosome, kunye nee-anti-histone antibodies.

Emva kweenyanga ezilithoba, inqanaba le-creatinine yesigulana lenyuka laya kwi-4.86 mg/dl, nto leyo eyafuna i-dialysis kunye nonyango lokunciphisa uxinzelelo lwegazi. Iziphumo zelebhu zibonise amanqaku e-SLE Disease Activity Index (SLEDAI) angama-23, nto leyo ebonisa imeko embi kakhulu. Ngenxa yoko, isigulana senziwa unyango lwe-CAR-T. Inkqubo yonyango yayilandelayo:

- Iveki enye emva kokufakwa kweeseli ze-CAR-T, izithuba phakathi kweeseshoni ze-dialysis zanda.

- Emva kweenyanga ezintathu emva kokufakwa, inqanaba le-creatinine lehle laya kwi-1.2 mg/dl, kwaye izinga lokucoca eliqikelelweyo le-glomerular (eGFR) lenyuke ukusuka kwi-8 ml/min/1.73m² ukuya kwi-24 ml/min/1.73m², nto leyo ebonisa isifo sezintso esingapheliyo sesigaba sesi-3b. Amayeza okunciphisa uxinzelelo lwegazi nawo ancitshisiwe.

- Emva kweenyanga ezisixhenxe, iimpawu zesifo samathambo sesigulana zaphela, izinto ezincedisayo i-C3 kunye ne-C4 zabuyela kwisiqhelo kwiiveki ezintandathu, kwaye ii-antinuclear antibodies, i-anti-dsDNA, kunye nezinye ii-autoantibodies zanyamalala. Umsebenzi wezintso wesigulana uphucuke kakhulu, kunye ne-proteinuria yeeyure ezingama-24 yehla yaya kwi-3400 mg, nangona yahlala iphezulu kulandelelwano lokugqibela, nto leyo ebonisa umonakalo ongaguqukiyo we-glomerular. Uxinzelelo lwe-plasma albumin lwaluqhelekile, kungekho ukudumba; uhlalutyo lomchamo alubonisanga zimpawu ze-nephritis, kwaye akukho hematuria okanye iiseli ezibomvu zegazi. Isigulana ngoku sibuyele kubomi obuqhelekileyo.