I-Systemic Lupus Erythematosus (SLE)-02

Isiguli singowesifazane oneminyaka engu-20 ubudala one-systemic lupus erythematosus (SLE) enzima futhi ethuthuka ngokushesha. Naphezu kokwelashwa nge-hydroxychloroquine sulfate, i-azathioprine, i-mycophenolate mofetil, kanye ne-belimumab, ukusebenza kwezinso kwakhe kwawohloka zingakapheli izinyanga ezinhlanu, okwaholela ku-nephritis enzima ene-proteinuria (inani le-creatinine lamahora angu-24 elifinyelela ku-10,717 mg/g) kanye ne-hematuria encane. Emasontweni amane alandelayo, izinga lakhe le-creatinine lenyuke laya ku-1.69 mg/dl (ibanga elijwayelekile lingu-0.41 ~ 0.81 mg/dl), elihambisana ne-hyperphosphatemia kanye ne-renal tubular acidosis. I-biopsy yezinso ibonise isigaba sesi-4 se-lupus nephritis. Inkomba yomsebenzi we-NIH eguquliwe yayingu-15 (ubuningi obungu-24), kanye ne-NIH chronicity index eguquliwe yayingu-1 (ubuningi obungu-12). Isiguli sasinamazinga aphansi okugcwalisa kanye nama-autoantibodies amaningi emzimbeni waso, njenge-antinuclear antibodies, i-anti-double-stranded DNA, i-anti-nucleosome, kanye nama-anti-histone antibodies.

Ngemva kwezinyanga eziyisishiyagalolunye, izinga le-creatinine lesiguli lenyuka laya ku-4.86 mg/dl, okudinga i-dialysis kanye nokwelashwa nge-antihypertensive therapy. Imiphumela yelabhorethri ibonise amaphuzu e-SLE Disease Activity Index (SLEDAI) angu-23, okubonisa isimo esibi kakhulu. Ngenxa yalokho, isiguli sathola ukwelashwa kwe-CAR-T. Inqubo yokwelashwa yayimi kanje:

- Isonto elilodwa ngemuva kokufakwa kweseli le-CAR-T, izikhawu phakathi kwezikhathi zokuhlanza igazi zanda.

- Ezinyangeni ezintathu ngemuva kokumuncwa, izinga le-creatinine lehle laya ku-1.2 mg/dl, kanti izinga lokuhlunga le-glomerular elilinganisiwe (eGFR) lenyuke lisuka ku-8 ml/min/1.73m² laya ku-24 ml/min/1.73m², okubonisa isigaba sesi-3b sesifo sezinso esingamahlalakhona. Imithi yokulwa nomfutho wegazi ophakeme nayo yehlisiwe.

- Ngemva kwezinyanga eziyisikhombisa, izimpawu zesifo samathambo sesiguli zaphela, izici ezihambisanayo C3 kanye ne-C4 zabuyela esimweni esijwayelekile zingakapheli amasonto ayisithupha, futhi ama-antinuclear antibodies, ama-anti-dsDNA, kanye namanye ama-autoantibodies anyamalala. Ukusebenza kwezinso kwesiguli kwathuthuka kakhulu, nge-proteinuria yamahora angama-24 yehla yaya ku-3400 mg, yize yahlala iphakeme ekulandeleni kokugcina, okubonisa umonakalo othile ongenakuguqulwa we-glomerular. Ukuhlushwa kwe-albhamuin egazini kwakujwayelekile, kungekho ukuvuvukala; ukuhlaziywa komchamo akubonisi zimpawu ze-nephritis, futhi kwakungekho hematuria noma amaseli egazi abomvu. Isiguli manje sesibuyele empilweni ejwayelekile.