荨麻疹患者外周血嗜碱性粒细胞表面CD63表达的研究

目的观察荨麻疹患者外周血中活化的嗜碱性粒细胞表面表达CD63的数量,探讨嗜碱性粒细胞的活化程度,为临床检测提供新方法。方法用屋尘螨浸液作划破试验,筛选敏感的荨麻疹患者。用CD63-FITC等抗体标记嗜碱性粒细胞,流式细胞技术检测CD63的表达情况。结果急、慢性患者活化嗜碱性粒细胞百分率分别为33.77～15.75%、11.66～5.25%,与正常人比较均有显著差异(P<0.05);经变应原刺激后,急、慢性患者活化嗜碱性粒细胞百分率分别为60.25～18.88%、22.22～7.89%,急、慢性患者活化前、活化后也均存在明显差异(P<0.05),而且急性患者活化程度更高(P<0.05)。结论通过测定嗜碱性粒细胞表达CD63可能有助于过敏的诊断。     

慢性自发性荨麻疹患者外周血嗜碱粒细胞CD63和CD203c的表达

目的：检测慢性自发性荨麻疹患者中外周血嗜碱粒细胞的活化状态。方法：采用流式细胞技术分别检测慢性自发性荨麻疹患者风团不同持续时间下（A组<2 h,15例;B组12~24 h,15例）、治疗后患者（C组,15例）及健康对照组（D组,15例）外周血嗜碱粒细胞CD63+和CD203c+的表达情况。结果：A、B、C三组外周血嗜碱粒细胞CD63+和CD203c+活化百分率（0.097±0.019,0.072±0.015,0.051±0.012）均高于对照D组（0.007±0.002,P<0.05）。A、B、C三组之间两两比较无显著差异（P>0.05）。结论：活化的嗜碱粒细胞可能参与了慢性自发性荨麻疹的发病过程,但与风团的持续时间无相关性。     

荨麻疹患者血清特异性IgE过敏原检测及两种氯雷他定的疗效比较

目的:了解322例荨麻疹患者的致病因素及各种因素之间的相互关系,比较2种氯雷他定治疗84例慢性特发性荨麻疹患者的疗效。方法:采用德国“敏筛”定量过敏原检测系统对322例荨麻疹患者进行了特异性IgE及过敏原的检测和分析,应用2种氯雷他定片治疗84例慢性特发性荨麻疹患者,并进行疗效对比和随访观察。结果:322例患者中有159例至少对1项过敏原阳性,阳性率为49.4%。平均阳性过敏原为(1.36±1.70)项;78例患者血清特异性总IgE阳性,阳性率为24.2%。2种氯雷他定片治疗前后患者症状和体征评分指数下降差异无统计学意义。治疗后,治疗组基愈率为37.2%,有效率为72.2%;对照组基愈率为39.0%,有效率为78.0%,两组疗效比较差异无统计学意义。结论:德国“敏筛”定量过敏原检测系统能较简便地检测特异性IgE和过敏原;国产氯雷他定治疗慢性特发性荨麻疹安全有效。     

人工荨麻疹患者神经肽Y和CD63的检测及意义

目的 探讨神经肽Y和活化的嗜碱性粒细胞在人工荨麻疹发病机制中的意义。方法 人工荨麻疹患者24例来自2011年8 - 12月河北医科大学第二医院皮肤科门诊,16例对照为除外过敏性疾病、躯体慢性疾病、神经系统及精神疾病的同期健康志愿者。用放射免疫分析法检测血浆神经肽Y的表达;用CD45-PERCP（多甲藻黄素-叶绿素-蛋白质复合物）、CD203c-藻红蛋白、CD63-异硫氰酸荧光素三联抗体标记嗜碱性粒细胞,流式细胞仪检测CD63的表达水平,计数活化嗜碱性粒细胞数量。 结果 人工荨麻疹患者与健康对照组神经肽Y的含量分别为（111.155 ± 36.832） ng/L和（104.456 ± 44.697） ng/L,两组差异无统计学意义（t = 0.198,P ＞ 0.05）;人工荨麻疹患者外周血活化嗜碱性粒细胞中位数（280.5 × 106/L）高于健康对照组（18.1 × 106/L）,两组差异有统计学意义（P ＜ 0.05）。结论 活化的嗜碱性粒细胞可能参与了人工荨麻疹的发病过程,而神经肽Y的作用尚不能确定。     

荨麻疹患者外周血T细胞亚群与抗组胺疗效关系的分析

目的: 确定外周血T细胞亚群与抗组胺治疗效果的关系.方法: 用流式细胞仪检测48例急性荨麻疹患者和67例慢性荨麻疹患者外周血CD3+、CD4+、CD8+T细胞值,分析其与抗组胺治疗效果间的关系.结果: 急、慢性荨麻疹患者抗组胺治疗无效组CD3+T细胞、CD8+T细胞构成比低于治疗显效组(P<0.05),CD4+/CD8+比值高于治疗显效组 (P<0.01),差异有统计学意义.结论: 荨麻疹患者的抗组胺治疗效果可能与CD8+T细胞增高有关.     

雷公藤多苷联合地氯雷他定治疗慢性荨麻疹临床观察

目的 观察雷公藤多苷和地氯雷他定治疗慢性荨麻疹的疗效.方法 108例患者随机分为2组,治疗组54例采用雷公藤多苷联合地氯雷他定口服,对照组54例采用单纯口服地氯雷他定.结果 两组疗效比较差异有统计学意义(P<0.01),治疗组复发率明显低于对照组(P<0.01).结论 雷公藤多苷联合地氯雷他定治疗慢性荨麻疹疗效及复发率优于单纯地氯雷他定.     

地氯雷他定治疗慢性荨麻疹疗效观察

目的 评价地氯雷他定治疗慢性荨麻疹的疗效.方法 治疗组66例,给予地氯雷他定口服;对照组58例,给予氯雷他定口服.疗程均为4周.结果 两组患者有效率比较差异无统计学意义(P>0.05),治疗组不良反应发生率明显低于对照组(P<0.05).结论 地氯雷他定治疗慢性荨麻疹疗效满意.     

孙杰

目的 观察枸地氯雷他定片治疗慢性荨麻疹的疗效以及对血清总IgE水平的影响。方法 选取我院2017年2月～2019年2月收治的慢性荨麻疹患者88例作为研究对象,采用双盲法随机均分为研究组(44例,采用枸地氯雷他定片治疗)与对照组(44例,采用盐酸左西替利嗪治疗)。分析比对两组患者治疗有效率与血清IgE水平。结果 研究组患者治疗有效率较对照组更高,且前者血清IgE水平较后者更低,两组间差异显著(P 0.05)。结论 慢性荨麻疹患者采用枸地氯雷他定片治疗,可有效改善患者症状,提升治疗有效率,降低患者血清免疫球蛋白水平,整体治疗效果较为显著,具有较高应用价值。     

复方甘草酸苷联合地氯雷他定治疗慢性荨麻疹疗效观察

目的:观察复方甘草酸苷联合地氯雷他定治疗慢性荨麻疹疗效.方法:治疗组口服复方甘草酸苷片剂75 mg,每天3次,地氯雷他定片5 mg,每天1次,均连服4周;对照组口服地氯雷他定片5 mg,每天1次,连服4周.结果:两组有效率比较差异有统计学意义(P＜0.05).结论:复方甘草酸苷联合地氯雷他定治疗慢性荨麻疹有效.     

盐酸氮卓斯汀治疗荨麻疹疗效及安全性观察

目的：观察盐酸氮卓斯汀片口服治疗急、慢性荨麻疹的有效性和安全性。方法：采用多中心、随机、双盲、双模拟阳性药平行对照方法，共治疗143例荨麻疹患者。试验组71例口服氮卓斯汀2mg，每日1次，对照组72例口服氯雷他定10mg，每日1次。急性荨麻疹疗程为14d，慢性荨麻疹为28d。结果：氮卓斯汀组，显效率为53．52％，有效率为76．06％；氯雷他定组，显效率为58．33％，有效率为79．17％，两组差异无显著性。氯雷他定组不良反应发生率为1．39％，氮卓斯汀组不良反应发生率为4．23％，两组比较差异无显著性。结论：盐酸氮卓斯汀治疗荨麻疹有效而安全。     

慢性荨麻疹患者外周血中CD8~+CD28~-T细胞检测结果分析

目的:探讨CD8~+CD28~-T细胞在慢性荨麻疹患者致病机制中的作用。方法:收集临床慢性荨麻疹(CU)病例83例,同时设立对照组64例进行比较。应用ELISA法检测研究对象血清中抗Ig E抗体、抗FcεRⅠ抗体浓度,流式细胞仪检测外周血中CD3~+、CD4~+、CD8~+、CD8~+CD28~-、CD4~+CD25~+T细胞比例,分析检测结果。结果:83名CU中,23例抗Ig E抗体为阳性,占27.7%(27/83);31例抗FcεRⅠ抗体为阳性,占37.3%(31/83)。CU患者外周血CD8~+T细胞比例、CD8~+CD28~-T细胞比例低于正常对照组(P0.05),CD4~+/CD8~+比值、CD4~+CD25~+T细胞比例均高于对照组(P0.05)。结论:CU患者机体外周血CD8~+CD28~-T细胞、CD4~+CD25~+T细胞比例与对照组相比存在差异,CD8~+CD28~-T细胞比例降低也可能是CU致病机制之一。     

Basophil CD63 expression assay on highly sensitized atopic donor leucocytes-a useful method in chronic autoimmune urticaria

BACKGROUND: The autoimmune subclass of chronic idiopathic urticaria (CU) has been characterized by the occurrence of biologically relevant IgG antibodies against the IgE molecule or the alpha chain of the high-affinity Fcepsilon receptor (FcepsilonRIalpha) on basophils and mast cells. These antibodies are usually detected by autologous serum skin testing and confirmed by histamine release studies, immunoblotting, or enzyme-linked immunosorbent assay, but not always. OBJECTIVES: To detect autoantibodies to the FcepsilonRIalpha in sera of CU patients by a modified serum-induced basophil activation test measured by flow cytometry (FCM) and to evaluate the relationship between the in vitro functional test, the autologous serum skin test (ASST), and the serum levels of IgE, eosinophil cationic protein (ECP) and antithyroid antibodies. METHODS: Sera of 30 patients with CU and 26 patients with systemic autoimmune diseases (systemic lupus erythematosus, dermatomyositis) were tested for CD63 activation marker expression on basophils by FCM. Leucocytes from two highly sensitized atopic donors (D(A1,) D(A2)) and one non-atopic donor (D(NA)) were incubated with patients' sera and double-labelled with anti-IgE and anti-CD63 antibodies. Subsequently, the percentage of CD63-expressing basophils was determined by using FCM. In all CU patients an ASST was carried out and the serum IgE, and ECP levels and antithyroid antibodies were evaluated. RESULTS: Twelve patients had a positive ASST and 14 patients a positive CD63 expression assay. There was a strong correlation between the ASST and CD63 assay. Sera from patients with systemic autoimmune diseases did not raise positive CD63 expression on basophils. There was a moderate negative correlation between the occurrence of atopic serum markers (IgE, ECP) and the ability of sera to induce CD63 expression on basophil cells of D(A2) (P < 0.05). The female sex was preponderant and antithyroid antibodies were more frequent. CONCLUSIONS: Our new technical observation demonstrates that basophils of highly sensitized atopic donors can be successfully used without priming with IL-3 for the in-vitro flow cytofluorimetric diagnosis of CU. With this investigation the characterization of the autoimmune origin of CU is based on an objective in vitro technique.     

Activated status of basophils in chronic urticaria leads to interleukin-3 hyper-responsiveness and enhancement of histamine release induced by anti-IgE stimulus

BACKGROUND: Basophils and mast cells are the main target cells in chronic idiopathic urticaria (CIU). Besides the basopenia, intrinsic defects of the anti-IgE cross-linking signalling pathway of basophils have been described in CIU. OBJECTIVES: We sought to investigate the profile of expression of activation markers on basophils of patients with CIU and to explore the effect of interleukin (IL)-3 priming upon anti-IgE cross-linking stimuli through expression of activation markers and basophil histamine releasability. METHODS: Evaluation of the surface expression of FcepsilonRIalpha, CD63, CD203c and CD123 on whole blood basophils of patients with CIU undergoing autologous serum skin test (ASST) was performed by flow cytometry. The effect of pretreatment with IL-3 in the anti-IgE response was analysed by the expression of basophil activation markers and histamine release using enzyme-linked immunosorbent assay. RESULTS: Blood basophils of patients with CIU were reduced in number and displayed increased surface expression of FcepsilonRIalpha, which was positively correlated with the IgE serum levels. Upregulation of expression of both surface markers CD203c and CD63 was verified on basophils of patients with CIU, regardless of ASST response. High expression of IL-3 receptor on basophils was detected only in ASST+ patients with CIU. Pretreatment with IL-3 upregulated CD203c expression concomitantly with the excreting function of blood basophils and induced a quick hyper-responsiveness to anti-IgE cross-linking on basophils of patients with CIU compared with healthy controls. CONCLUSIONS: Basophils of patients with CIU showed an activated profile, possibly due to an in vivo priming. Functionally, basophils have high responsiveness to IL-3 stimulation, thereby suggesting that defects in the signal transduction pathway after IgE cross-linking stimuli are recoverable in subjects with chronic urticaria.     

Defective functions of circulating CD4+CD25+ and CD4+CD25- T cells in patients with chronic ordinary urticaria

BACKGROUND: Patients with chronic ordinary urticaria (CU) are divided into two groups: 30-50% have chronic autoimmune urticaria, and the remainder have chronic idiopathic urticaria. CD4(+)CD25(+) regulatory T (Treg) cells play critical roles in maintaining peripheral tolerance and preventing autoimmunity, but the characteristics of Treg cells have not yet been defined in CU. OBJECTIVE: To identify whether CD4(+) T cells play an important immunoregulatory role in the etiology of CU, we determined the frequencies and functions of circulating CD4(+)CD25(+) and CD4(+)CD25(-) T cells in CU patients and healthy control subjects, with special focus on the characteristics of CD4(+)CD25(+) T cells. METHODS: Peripheral blood mononuclear cells (PBMCs) were obtained from CU and healthy controls in this study. The frequency of CD4(+)CD25(+) T cells in PBMCs was detected by flow cytometry. The expression levels of forkhead box P3 (FOXP3) and transforming growth factor-beta (TGF-beta) in CD4(+)CD25(+) T cells were detected by real-time PCR. Furthermore, the suppressive function of CD4(+)CD25(+) T cells was analyzed. Additionally, the Th1/Th2 cytokine secretory profile in mitogen-stimulated CD4(+)CD25(-) T cells was measured by ELISA. RESULTS: An increased frequency of CD4(+)CD25(+) T cells was observed in CU patients (n=19) compared to control subjects (n=7). No significant difference was detected in the expression levels of FOXP3 or TGF-beta between CU patients (n=14) and control subjects (n=7). Strikingly, the suppressive capacity of CD4(+)CD25(+) Treg cells from 2 of 5 CU patients was partially defective. We also found that cytokine production from CD4(+)CD25(-) T cells was significantly reduced in CU patients (n=9) compared to healthy donors (n=11). CONCLUSIONS: Our data demonstrate that CD4(+)CD25(+) and CD4(+)CD25(-) T cells in PBMCs exhibit defective functions in CU patients.     

Significant correlation between the CD63 assay and the histamine release assay in chronic urticaria

BACKGROUND: Antibodies directed to the alpha subunit of the high affinity IgE receptor and the IgE molecule are proposed to be of pathogenetic relevance in a group of patients with chronic urticaria (CU). The diagnosis of autoimmune chronic urticaria (ACU) is difficult; the autologous serum skin test (ASST) seems to be a useful screening test, but reliable, additional confirmatory methods are needed. OBJECTIVES: To assess the diagnostic value of a modified serum-induced basophil activation test, the CD63 expression assay, in the diagnosis of ACU by comparing the results of the CD63 assay with the results of the histamine release (HR) test, the ASST and serum levels of soluble CD40 ligand (sCD40L). METHODS: Using basophils from an atopic (DA) and a nonatopic (DNA) donor the activity of sera of 72 patients with CU were measured in HR assay by enzyme-linked immunosorbent assay and in CD63 expression assay by flow cytometry. An ASST was carried out in all patients; in 30 of the 72 patients sCD40L was detected and correlations were derived between the different assays. Sera of 20 normal controls and 26 patients with systemic autoimmune diseases were also tested in the HR assay and in the CD63 expression assay. RESULTS: Histamine-releasing activity was detected in the sera of 51% (DA) and 32% (DNA) of CU patients and 57% (DA) and 28% (DNA) of sera upregulated CD63 expression on the surface of basophils from the different donors. There was a significant correlation between the HR and the CD63 assays carried out on both donors, but the ASST showed a strong correlation with the HR assay only for basophils from the DA. The serum level of sCD40L was significantly higher in patients with CU compared with controls, but the difference between the autoimmune and the nonautoimmune groups was not significant. CONCLUSIONS: The CD63 expression assay seems to be a reliable functional test in the diagnosis of ACU, particularly if highly sensitive donor basophils are used, but the determination of the sCD40L serum level was not sufficient to differentiate between the autoimmune and the nonautoimmune patient groups.     

荨麻疹患者外周血淋巴细胞亚群和IL-15,IL-21,IgE检测

目的探讨外周血T,B,NK淋巴细胞亚型及血清白细胞介素(IL)-15,IL-21,IgE变化与荨麻疹发病机制的关系。方法用流式细胞仪检测急性荨麻疹(AU)、慢性荨麻疹(CU)患者和健康献血者外周血CD3+,CD4+,CD8+T细胞、B细胞、NK细胞的构成比,并用ELISA法检测血清IL-15,IL-21,IgE水平,分析其与病情、病程的关系。结果 AU患者的外周血T,B,NK淋巴细胞亚型与正常对照组间差异无显著性(P0.05);CU患者CD4+/CD8+比值、NK细胞高于对照组,而CD8+低于对照组(P0.05),AU和CU组血清IL-15,IL-21水平均低于对照组(P0.01),血清IgE相反(P0.05);AU患者的CD8+T细胞高于CU患者,CD4+/CD8+比值低于CU患者(P0.01),余未见明显区别。CU患者的CD3+,CD8+T细胞与症状评分呈负相关,B细胞与症状评分、病程呈正相关,IgE与IL-21均呈负相关;而AU患者未见明显相关。结论 AU,CU患者存在血清IL-15,IL-21和IgE水平的异常,CU患者还存在外周血T,B,NK淋巴细胞亚型的异常。这些异常可能是荨麻疹发病因素之一,其相互作用还可能引起CU反复发作。     

Association of a new-type prostaglandin D2 receptor CRTH2 with circulating T helper 2 cells in patients with atopic dermatitis

Prostaglandin D2 is known to be the major prostanoid produced by allergen-activated mast cells, but its role in the formation of allergic diseases is not well established because of complexity of its receptor system and lack of appropriate inhibitors. We have recently identified a new-type prostaglandin D2 receptor, named CRTH2. Studies with normal subjects have shown that CRTH2 appears to be selectively expressed by T helper 2 cells but not T helper 1 cells among circulating CD4+ lymphocytes. The exact correlation between CRTH2 and T helper 2 cells in various disease settings and the impact of CRTH2-mediated prostaglandin D2 activities on various T helper 2 responses in vivo still remain to be elucidated, however. In this study, we investigated the correlation between CRTH2 and T helper 2 cells among circulating CD4+ lymphocytes in normal adults and patients with atopic dermatitis, a T-helper-2-involving disease. The results showed that virtually all CRTH2+CD4+ lymphocytes had a pure T helper 2 phenotype and formed not all but a large proportion of circulating T helper 2 cells for both normal and atopic dermatitis subjects. In chemotaxis assays, peripheral blood CRTH2+CD4+ lymphocytes were significantly attracted by prostaglandin D2 as well as by a typical T-helper-2-attracting chemokine, thymus and activation regulated chemokine, whereas they showed little chemotactic migration toward typical T-helper-1-attracting chemokines, macrophage inflammatory protein 1beta and interferon-gamma-inducible protein 10. Furthermore, in atopic dermatitis patients, a preferential increase of CRTH2+ cells was noted within the disease-related cutaneous lymphocyte-associated antigen-positive, but not the cutaneous lymphocyte-associated antigen-negative, CD4+ lymphocyte compartment. Our results suggest the involvement of the prostaglandin D2/CRTH2 system in both normal and pathogenic T helper 2 responses.     

Cytokine production of CD4+ and CD8+ peripheral T lymphocytes in patients with chronic idiopathic urticaria

The aim of this study was to investigate the characteristic cytokine pattern of patients with chronic idiopathic urticaria. Using flow cytometry, we examined the frequency of IL4, IL-10, IL-13 and IFN-gamma producing CD4+ and CD8+ T cells in the peripheral blood mononuclear cells at a single cell level. In patients with chronic idiopathic urticaria, the frequency of IL-10 producing CD4+ and CD8 + T cells was significantly higher than that of control subjects, while the frequency of IFN-y producing helper and cytotoxic T cells was significantly lower. The proportion of IL-4 producing CD4 + T cells from patients with urticaria was significantly lower. The ratio of IL-4 producing CD8 + T cells and the proportion of IL-13 producing CD4 + and CD8 + T lymphocytes did not show any significant difference between patients and controls. In our study, we could observe neither a dominant Th1 nor a dominant Th2 type cytokine pattern. We found a significant elevation in the intracellular IL-10 level which may be the cause of the down-regulated Th1 and Tc1 and partly Th2 lymphocyte functions.     

Role of the subgroups of T,B, natural killer lymphocyte and serum levels of interleukin‐15, interleukin‐21 and immunoglobulin E in the pathogenesis of urticaria

The immunological characterization in the pathogenesis of urticaria, mainly regarding cytokine profile, needs more investigation. In this study, subgroups of the T, B and natural killer (NK) lymphocyte from peripheral blood and serum levels of interleukin (IL)‐15, IL‐21 and immunoglobulin (Ig)E were examined in patients with acute urticaria (AU) and chronic urticaria (CU). Moreover, symptom scores and course of the patients were assessed. The percentage of NK cells and the ratio of CD4⁺/CD8⁺ increased, however, CD8⁺ decreased in CU compared to controls (P < 0.01). But no significant changes of T, B and NK lymphocyte were found in AU. IL‐15 and IL‐21 significantly decreased in AU and CU, but IgE increased. CU with a positive autologous serum skin test were more likely to be associated with longer course and higher CD3⁺, B cells and IL‐21, and lower IgE (P < 0.01). Weak negative correlations were demonstrated between CD3⁺, CD8⁺ and scores in CU (r = ?0.23, ?0.25, P < 0.05). Significant correlations were found between B cells and scores and course in CU (r = 0.49, 0.65, P < 0.01). Moreover, a significant correlation was found between IL‐21 and IgE (r = 0.42, P < 0.01) in CU. But no significant correlations were found in AU. Our findings supported the concept that both humoral immunity and cellular immunity dysregulation in the pathogenesis of urticaria – mainly related to the decrease of the serum levels of IL‐15 and IL‐21 – may induce the increasing expression of IgE produced by B cells.     

T、B、NK细胞亚型与慢性荨麻疹发病机制的关系

目的 探讨T、B、NK细胞亚型与慢性荨麻疹发病机制的关系。方法 用流式细胞仪检测51例慢性荨麻疹患者和30例健康献血者外周血CD3+、CD4+、CD8+ T细胞、B细胞、NK细胞的构成比，并计算CD4+/CD8+比值，分析其与病情、病程和抗组胺治疗之间的关系。结果 慢性荨麻疹患者CD8+ T细胞构成比27.20% ± 8.22%低于正常人对照组29.9% ± 3.74%（P < 0.05），CD4+/CD8+比值（1.48 ± 0.62）、NK细胞构成比21.20% ± 10.84%高于正常人对照组（分别为1.24 ± 0.27，17.5% ± 3.56%，P < 0.05）；抗组胺治疗无效组CD3+ T细胞61.81% ± 11.70%、CD8+ T细胞24.00% ± 7.79%、B细胞10.78% ± 2.07%构成比低于抗组胺治疗显效组（分别为75.74% ± 2.36%，34.22% ± 9.30%，15.25% ± 4.10%；P < 0.05，P < 0.01， P < 0.05），CD4+/CD8+比值（1.67 ± 0.76）、NK细胞构成比28.61% ± 12.62%均高于抗组胺治疗显效组（分别为1.17 ± 0.41，12.78% ± 6.02%，P < 0.01）。慢性荨麻疹患者的CD3+、CD8+ T细胞构成比与症状评分呈负相关性（r = -0.31，-0.28，P < 0.05），B细胞构成比与症状评分、病程呈正相关性（r = 0.53，0.55，P < 0.01）。结论 慢性荨麻疹患者存在T、B、NK细胞亚型构成紊乱，在慢性荨麻疹及其耐抗组胺的发病机制中，可能有体液免疫参与。