双靶点嵌合抗原受体T细胞治疗系统性红斑狼疮患者停药后安全孕产1例  

Safe pregnancy and delivery in a female patient with systemic lupus erythematosus after discontinuation of dual-target chimeric antigen receptor T cells therapy

作　　者：王明霞[1] 丁菱[1] 王敏[1] 邹婵娟[1] 颜丝语 梁颖文 王伟佳[2] 何善智[1] WANG Mingxia;DING Ling;WANG Min;ZOU Chanjuan;YAN Siyu;LIANG Yingwen;WANG Weijia;HE Shanzhi(Department of Rheumatology and Immunology,Zhong-shan People’s Hospital,Zhongshan 528403,Guangdong,China;Department of Advanced Diagnostic and Clinical Medicine,Zhong-shan People’s Hospital,Zhongshan 528403,Guangdong,China)

机构地区：[1]中山市人民医院风湿免疫科,广东中山528403 [2]中山市人民医院先进诊断与先进治疗临床研究中心,广东中山528403

出　　处：《北京大学学报（医学版）》2024年第6期1119-1125,共7页Journal of Peking University:Health Sciences

基　　金：中山市社会公益与基础研究项目(2023B1034);中山市卫生局医学科研项目(2021A020173)。

摘　　要：系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种弥漫性、全身性自身免疫病,可累及多个器官和系统,皮肤、肾脏是较常累及的器官。SLE患者血清中可检测到多种自身抗体和免疫指标异常。目前认为B细胞活化失调在SLE发病中起着关键性作用,异常活化的B细胞分泌自身抗体,并通过补体激活和抗体依赖性细胞介导的细胞毒作用,造成多个脏器功能受损。Systemic lupus erythematosus(SLE)is a diffuse,systemic autoimmune disorder that can impact multiple organs and systems,with patients exhibiting abnormal levels of various autoantibodies and immune markers in their serum.It is currently understood that dysregulation of B cells activation plays a pivotal role in the pathogenesis of SLE,as aberrantly activated B cells produce autoantibodies that inflict damage on multiple organs through complement activation and antibody-dependent cell-mediated cyto-toxicity.Traditional therapies for SLE may prove ineffective for certain patients or lead to adverse reactions.In most instances,conventional treatment merely alleviates symptoms and necessitates lifelong immunotherapy.A limited number of clinical cases have explored chimeric antigen receptor T cells(CAR-T)therapy as a potential treatment for autoimmune diseases such as SLE.Research indicates that CAR-T can specifically target CD19 expressed on the surface of B cells and plasma cells,achieving profound depletion while minimizing drug-related side effects.This report details a female patient diagnosed with SLE and lupus nephritis who was successfully treated using dual-targeting B cells maturation antigen CAR-T by our research team;following treatment,she ceased steroid and immunomodulator use,attaining sustained remission without these medications.The patient was a 23-year-old female.Multiple examinations in other hospitals and in our hospital showed positive anti-double-stranded DNA(dsDNA)antibody and low complement C3.Renal biopsy in our hospital showed lupus nephritisⅣ-G(A/C),and National Institutes of Health(NIH)activity index(AI)score=4.She was diagnosed with“SLE,lupus nephritis(LN)”.She was treated with hormones,immunosuppressants and Chinese medicine,but the effect was not good.After the CAR-T treatment,She stopped using hormones and immune agents and achieved continuous remission with zero hormones and zero immune agents.She became pregnant six months after CAR-T infusion,and gave birth to a healthy full-te

关 键 词：系统性红斑狼疮 CAR-T细胞 妊娠和分娩 抗风湿药 

分 类 号：R593.241[医药卫生—内科学]