Character Highlight? ?角色介紹
B-lymphocyte? ?B淋巴細(xì)胞

The B-cell is perhaps my favorite immune cell, along with the macrophage. It is a member of the adaptive immune system, and as such responds to specific stimuli including but not limited to bacteria, viruses, and parasites. They are the effectors of the humoral component of adaptive immunity, which is to say that they are the cells chiefly responsible for producing antibodies.
B細(xì)胞，加上巨噬細(xì)胞，可能是我最喜歡的免疫細(xì)胞。B細(xì)胞屬于適應(yīng)性免疫系統(tǒng)（即“后天免疫系統(tǒng)”），會對外界刺激作做出反應(yīng)，比如對細(xì)菌，病毒，還有寄生蟲作出反應(yīng)。它們是體液免疫系統(tǒng)的適應(yīng)器。這是啥意思？就是說，B細(xì)胞主要負(fù)責(zé)生產(chǎn)抗體。


What are antibodies (AKA immunoglobulins)? They are small, Y-shaped proteins that can recognize specific peptide and other structures (known as antigens). When antibodies bind such antigens, they can help remove them by "flagging" them to the other cells of the immune system, and through a few other mechanisms. First, by coating a foreign microbe, antibodies can reduce their ability to interact with their surroundings and target tissues. Second, coating of a microbe, known as "opsonization", marks it for consumption by macrophages and other cells. Third, antibodies can activate complement, a sort of biochemical kill-switch assembly that floats in your plasma, only activated under specific circumstances.
什么是抗體（也叫“免疫球蛋白”）？它是小小的，Y形狀的蛋白質(zhì)，可以識別特定的蛋白質(zhì)結(jié)構(gòu)（后者也叫“抗原antigen”）。抗體和抗原結(jié)合時，會想辦法消滅抗原；它就會給抗原貼個flag（標(biāo)簽），讓免疫系統(tǒng)的其他細(xì)胞識別出它們。首先，抗體會附著在微生物的表面，用于減少病菌對周圍環(huán)境和組織的影響。附在微生物表面的這個動作，又叫“調(diào)理素作用”，就是給微生物立個flag，表示病菌可以被巨噬細(xì)胞或者其他細(xì)胞吃掉。最后，抗體可以激活“補(bǔ)體”，就是浮在你血漿里的某種生化的‘殺手開關(guān)’，只能在特定的條件下激活。

再次強(qiáng)調(diào)：抗體(antibody)，就是免疫球蛋白(immunoglobulins)

There are other interactions too, as we will see. There are many types (specifically, isotypes) of immunoglobulins, which are defined by changes in the "Fc" region of the protein (basically, the base of the Y), which confers different functionality. IgA is responsible for mucosal immunity. IgG is sort of a general effector with many subclasses (1-4). IgM is a short-term effector and usually precedes IgG. IgE plays a role in parasite defense and is involved in allergic reactions.
抗體還有些其他的作用，一會兒就會看到。免疫球蛋白有很多種，它根據(jù)其底部的“Fc”區(qū)域的（即Y的底部）的不同，從而分出不同種類，也會因此有不同的功能。IgA（免疫球蛋白A）負(fù)責(zé)黏膜免疫；IgG（免疫球蛋白G）是普遍型效應(yīng)器，包含許多亞種（subclass 1-4）。IgM是短期效應(yīng)器，通常是出現(xiàn)在IgG之前。IgE負(fù)責(zé)抵抗寄生蟲，以及參與到過敏反應(yīng)。

IgA can form \"dimers\", made of two antibodies back-to-back, while IgM can form \"pentamers\", made of five.
IgA可以形成“二聚體”，就是兩個抗體背靠背連在一起，而IgM可以形成五巨頭，啊不，“五聚體”。

up注：這次的新冠病毒期間，你一定聽說過‘核酸檢測’，它用來判斷病人是否感染了病毒。除了核酸檢測，還有一種辦法用于幫助確診，就是‘抗體檢測’，檢查的就是IgM和IgG這兩種抗體。

新冠病毒進(jìn)入身體后，免疫系統(tǒng)就會針對這種病原體發(fā)生作用，產(chǎn)生相應(yīng)抗體。

病毒入侵約一周后（即14天內(nèi)），產(chǎn)生的是IgM抗體，但是它存活時間比較短。在入侵后的2-4星期里（即14天以后），存活時期更長的抗體，IgG會產(chǎn)生。

但是，這種檢測方法不是特別靠譜，因?yàn)橛行┎∪丝赡芤呀?jīng)感染病毒，但身體沒產(chǎn)生抗體（假陰性），反之亦然（假陽性）。只能作為輔助參考。

The discovery of immunoglobulins is incredibly important to the field of not just medicine but biology and chemistry as a whole, as we have learned to engineer immunoglobulins in a way that allows us to specifically target certain antigens. This is useful everywhere from laboratory techniques (I may use immunohistochemistry to determine if a tumor expresses a certain growth factor receptor) to therapeutics (the new paradigm in cancer treatment revolves around immunotherapy using engineered monoclonal antibodies against cancer antigens).
免疫球蛋白的發(fā)現(xiàn)，不僅對醫(yī)學(xué)很重要，對生物和化學(xué)也很重要。我們可以控制免疫球蛋白，讓它去攻擊特定的抗原。從實(shí)驗(yàn)技術(shù)（我可以用‘免疫組織化學(xué)’，去看腫瘤是否表達(dá)了某種成長因子受體）到現(xiàn)實(shí)的治療學(xué)（癌癥治療的新方法就是免疫療法，它利用創(chuàng)造的單克隆抗體去攻擊癌癥抗原），它的用處都很廣。


So, what else to say about the B-cell? In a nutshell, they form in the bone marrow from the same precursor as T-cells and can either mature there or in various other tissues. Their maturation largely revolves around their ability to not only recognize foreign antigens, but also not overreact to normal "self" antigens. This is an extremely complex process that we do not need to go into, but note that one B-lymphocyte expresses one type of B-cell receptor (BCR, which is essentially an antibody that is bound to its membrane), and upon the right stimulation/activation it clonally expands, dividing to produce more B-cells. The mature form of the B-cell is the plasma cell, which has a distinctive cytomorphology and is tasked with just churning out high volumes of antibody.
那關(guān)于B細(xì)胞還能說些什么呢？簡單來說，它們出生在骨髓，它的前身和T細(xì)胞的前身一樣。它們可以在骨髓里成熟，也可以在其他組織里成熟。B細(xì)胞的成熟，很大程度上不僅取決于辨認(rèn)外來抗原的能力，也要看它會不會對正常的“自身”抗原產(chǎn)生過激反應(yīng)。這個過程蠻復(fù)雜的，我就不細(xì)講了，但是注意，一個B淋巴細(xì)胞表只達(dá)一種B細(xì)胞的受體(B-cell receptor, BCR, 就是結(jié)合在B細(xì)胞膜上的抗體)，在適當(dāng)?shù)拇碳?激活下，它會無性繁殖，分裂成更多的B細(xì)胞。成熟的B細(xì)胞是“漿細(xì)胞”。漿細(xì)胞的形狀獨(dú)特，任務(wù)就是量產(chǎn)抗體。

In addition, a small subset of matured B-cells become memory cells, to help expedite the adaptive response the next time its specific antigen is encountered. Okay, let's get to the episode.
另外，少量成熟的B細(xì)胞會變成‘記憶細(xì)胞’，以便下次遇到同樣的抗體時，做出更快的反應(yīng)。好了，開講劇情。


(to be discussed: Neutrophil, macrophage, mast cell, basophil, dendritic cell, CD4+ helper T-cell, T-regulatory cell, NK cell)
（以后還要講的人物：嗜中性粒細(xì)胞，巨噬細(xì)胞，肥大細(xì)胞，嗜堿性粒細(xì)胞，樹狀細(xì)胞，CD4+ 輔助T細(xì)胞，調(diào)節(jié)性T細(xì)胞，NK細(xì)胞）

Episode 5 - Cedar Pollen Allergy
第五集：杉樹花粉過敏


Foreword: I'm happy to see an episode that doesn't revolve around a true infectious etiology. Looking up bug virulence factors was getting old...
前言：終于有一集不說感染病了，看病毒已經(jīng)看煩了。。。


It's very interesting how the immune cells are all excited about a foreign body that hasn't actually contacted the body yet. Your body doesn't have a way of "knowing" until actual contact is made.
免疫細(xì)胞對即將到來的外來物這么興奮是鬧哪樣。外來物和身體接觸之前，你身體是不會知道的。
CD4+ cells do not play a major role in immunity. As testament to that, plenty of severely HIV-affected patients can still experience allergic reactions--supposedly, they experience even more.
CD4+細(xì)胞對免疫系統(tǒng)沒有太大的作用。證據(jù)就是，患嚴(yán)重艾滋病的病人，還會有過敏反應(yīng) - 而且還會反應(yīng)得更劇烈。

Woof, okay. This is another regional malady the likes of which we don't often specifically see in the west. Like with Anisakis though, our principles still apply. Seems that this cedar pollen is due to Cryptomeria Japonicum, which like many other plants releases pollen in a characteristic seasonal fashion.
哇，又是一個在西方不太常見的區(qū)域性疾病。這個雪松花粉貌似來自日本柳杉，和許多其他的植物一樣，會在特定的季節(jié)傳播花粉。

Touchdown! I suppose the ocean there represents the tear film, a surprisingly complex fluid layer that overlies your eyes that is normally replenished by glands when you blink. The tear film is actually important to your vision, as it does have refractive effect. The head & neck is often the first point of ingress for environmental allergens.
觸地！我覺得海洋代表了‘淚液膜’。它是蠻復(fù)雜的液體層，覆蓋在你的眼睛上。你眨眼時，膜里的液體就會得到補(bǔ)充。淚液膜對視覺很重要，因?yàn)樗姓凵渥饔谩?strong>頭部和頸部通常是外界過敏源最先進(jìn)入的地方。

I'm trying to work out what this "drain" is that the allergens are escaping through. Perhaps it represents the lacrimal duct, which drains tears into the nasal cavity, or perhaps it is referring to lymphatic channels...I honestly do not know if lymphatic channels are present on the surface of the eye; it's a highly specialized site that I should probably review a bit.

我在想這些過敏原出來的“下水道”是什么。也許它代表“淚小管”，它會把眼淚排到鼻腔，也許它代表淋巴管。。。。我還真不知道淋巴管會不會在眼睛表面出現(xiàn)。這個問題太專業(yè)了，我得查查。

Why is the neutrophil attacking a pollen granule? As far as I am aware they do not express the sorts of antigens that a neutrophil's pattern recognition receptors would be excited by. But this guy also fought viruses in past episodes, so I guess he's really special.
這個白細(xì)胞攻擊花粉干嘛？據(jù)我所知，花粉不會釋放抗原，讓嗜中性粒細(xì)胞檢測出它們。但是這家伙以前還打過病毒，所以只能說他很特別吧。


5m25s: Phagocytosis is indeed carried out by neutrophils, but that is generally not for recognition like it is in antigen-presenting cells like macrophages. Neutrophils eat to kill, not eat to learn.
‘嗜中性粒細(xì)胞’的確會有‘吞噬作用’，但是通常不是為了識別病原——那是‘抗原呈遞’型細(xì)胞的工作，比如巨噬細(xì)胞。嗜中性粒細(xì)胞吃是為了殺人，而不是學(xué)習(xí)。

A memory B-cell! He recognizes the antigen, so this guy probably was part of a prior immune response to the same allergy. Funny how he acts all worked up when in reality he's been churning out the very antibodies which will precipitate the doomsday he foretells. Wait, is this guy a memory B cell or a memory T cell?
記憶B細(xì)胞！他認(rèn)識這個抗原，所以這家伙八成之前參與過同一種過敏反應(yīng)。他可真能演啊，因?yàn)楝F(xiàn)實(shí)里，他正大量生產(chǎn)抗體 —— 就是他說的會帶來末日的那種抗體。等等，這家伙是記憶B細(xì)胞還是記憶T細(xì)胞？

Oh, a legend that has been passed down. As far as I'm aware memory cells do not "share" memory. One memory cell recognizes one antigen.
哦，代代流傳的傳說。據(jù)我所知，記憶細(xì)胞不會“共享”記憶。一個記憶細(xì)胞只識別一種抗原。

Why is the pollen destroying stuff? Pretty sure it just floats around accomplishing nothing.

哎我去，為啥這個花粉會搞破壞？很確定它就是到處飄，啥都不干。


B-cell is here! Or a plasma cell? Whatever, some B-lymphocyte. As you probably guessed, his Y-shaped rifle is a nod to the structure of the immunoglobulins he secretes. Here he is producing lots of IgE to respond to the offending invaders, but in reality the IgE is always produced (once the patient has been properly sensitized) and is present at a low level, often already bound to the surfaces of mast cells & basophils, awaiting the right antigen to bind. IgE also has no direct cytotoxic effect. Actually this scene is very far off from how the allergic response begins, but the true process is more confusing.
B細(xì)胞登場！還是漿細(xì)胞？管他呢，反正是某種B淋巴細(xì)胞。也許你已經(jīng)看出來了，他手上Y型的槍致敬了他產(chǎn)生的免疫球蛋白的結(jié)構(gòu)。這里，他搞出了一大堆IgE去對抗入侵者。但是現(xiàn)實(shí)中，IgE會一直被生產(chǎn)出來，只是含量比較低，通常都是吸附在‘肥大細(xì)胞’和‘嗜堿性粒細(xì)胞’的表面上，等著和適合的抗原結(jié)合。IgE沒有直接的細(xì)胞毒素作用?，F(xiàn)實(shí)中，過敏反應(yīng)的初始階段，和動畫里挺不一樣的，實(shí)際過程更混亂。

Mast cells are tissue-resident granuocytes (of sorts) that are similar to basophils but should be considered as distinct/different. See this discussion from last week for more details on them.
肥大細(xì)胞是住在組織里的粒細(xì)胞（大概），和嗜堿粒細(xì)胞類似，但是還不太一樣。具體詳見上一集的帖子。


What you should know now is that the mast cell is responsible for Type 1 hypersensitivity reactions, which is exactly what is going on here. IgE bound to their surfaces, when cross-linked by the right stimulatory antigen, results in rapid release of their granules, which contain things like histamine and various leukotrienes, which promote inflammation by acting as chemoattractants and by promoting vascular leakage.
肥大細(xì)胞參與到1型過敏反應(yīng)的過程，和這里描述的基本一致。IgE跑到肥大細(xì)胞的表面，當(dāng)它適當(dāng)?shù)目乖宦?lián)在一起時，就會讓肥大細(xì)胞快速“脫?！?/strong>。這些顆粒中包含了‘組織胺’，各種‘白三烯’；這些物質(zhì)會通過‘化學(xué)引誘’和‘血管滲漏’ 引起炎癥。

up注：‘肥大細(xì)胞’脫粒的過程挺獵奇的，類似于自殺性爆炸行為，具體請見第12集的解釋。

Histamine is actually a relatively small, simple molecule, but it has extremely variable effects and is involved in multiple processes in the body, from driving edema like this to promoting acid secretion in the stomach and also has a role in neural signaling.
組織胺是相對比較小的、簡單的分子，但是它產(chǎn)生的作用非常多；它還參與了身體里多種反應(yīng)，比如這里的‘水腫’，比如刺激胃酸的產(chǎn)生。它在神經(jīng)信號里也起作用。


People are getting washed away by the "histamine", but to be clear: The fluid in edema and vascular leakage is basically the same fluid that composes your serum and your interstitial fluids. It is just allowed to leak forth from vessels under histamine's influence--this is what causes runny noses.
大家看到“組織胺”就害怕，但其實(shí)，水腫和“血管滲漏”里的液體，和你的“血清”、“間質(zhì)液”里的液體是一樣的。只是在‘組織胺’的影響下，液體從血管里流出來了而已 —— 導(dǎo)致你流鼻子。

Hmm, who are these orange guys?
這些橘紅色的家伙是誰？

Actually, I am very unclear on what this "emergency response" is, or what the "secretory center" is meant to represent. We saw B-cell coming out of there...does that make it a lymphoid aggregate? It is not plainly obvious. Once the mast cells degranulate, I am not familiar with any additional "killswitch" that is activated that further heightens the hypersensitivity reaction.
這“緊急反應(yīng)”到底是個啥？“分泌中心”又是個啥？B細(xì)胞倒是從那里走出來。。。難道那里是‘淋巴結(jié)’？不太像。在肥大細(xì)胞脫粒后，還有別的開關(guān)引更加刺激過敏反應(yīng)嗎？我不清楚。

The increased presence of neutrophils makes sense. They will be attracted to any inflamed tissue even in the absence of bacterial signals due to the cytokines secreted there. Wonder why we don't see any eosinophils though.

更多的中性粒細(xì)胞出現(xiàn)，挺對的。即便沒有細(xì)菌的信號，他們也會沖向發(fā)炎的組織，因?yàn)槟抢锓置诹思?xì)胞因子。不知道為啥沒看到嗜酸性粒細(xì)胞。

Oh, lemme explain the symptoms in allergic rhinitis. Drippiness is from the histamines promoting vascular leak and edema. Coughing is often from irritation of the vocal cords from post-nasal dripping. Sneezing is from irritation of nerves in the nasal mucosa. Redness is a direct effect of the inflammation (more blood cells!). I don't know how tears are stimulated here, I'll trust the anime on this one. So far all of these narrations are correct.

我來解釋下過敏性鼻炎。流鼻子是因?yàn)椤M織胺’引發(fā)了‘血管滲漏’和‘水腫’，咳嗽通常是因?yàn)槁暤朗艿搅舜碳ぁ?strong>噴嚏是因?yàn)楸丘つど系纳窠?jīng)受到刺激。紅腫是因?yàn)榘l(fā)炎（更多紅細(xì)胞！）。我不清楚眼淚是如何產(chǎn)生的，但是我相信動畫里講的。目前這些講解都是對的。

（過敏性的癥狀包括：流鼻水，流淚，噴嚏，眼睛紅腫）

Let me share what is going on histologically...

Nasal mucosa in allergic rhinitis. The stromal tissue below looks cleared out, a result of waterlogging in edema. It is infiltrated by numerous inflammatory cells, prominently eosinophils. It is hard for us to see here but we expect to see increased numbers of mast cells and basophils as well.

從組織學(xué)上來講講這些過程……

過敏性鼻炎的鼻黏膜。因?yàn)樗[，下面的基質(zhì)組織貌似已經(jīng)被沖沒了。大量炎癥細(xì)胞，特別是嗜酸性細(xì)胞，會滲透到這里。雖然我們看不太出來，但是應(yīng)該也會有更多的肥大細(xì)胞和嗜堿性細(xì)胞到這里。

Okay, this will require some discussion. It looks like a steroid has been sent in from outside the body to help limit this inflammatory response. First of all, we can't tell how it is being administered. Red blood cell delivered it, which suggests it is in systemic circulation, further implying that it was an orally (or parenterally) administered steroid. This is not a standard practice in western medicine, and I would be surprised to hear if it was standard in Japan, frankly. A topical steroid (say, given as a nasal spray) would be completely appropriate, but steroids have pleiotropic effects and shouldn't be given systemically for local symptoms. In the short term, it is probably safe, but should be limited. An antihistamine would be a more common oral drug for allergic rhinitis.

這里需要多討論下。身體外部注入了類固醇，用于減緩炎癥反應(yīng)。首先，我們不能判斷它是如何攝入的。它由紅細(xì)胞運(yùn)輸，所以應(yīng)該是來自血液循環(huán)，暗示它是口服激素。在西方，這種方法不是很常見，其實(shí)個人覺得在日本也不常見。用局部類固醇（比如‘鼻用噴霧’）就可以了。動畫里這種全身性類固醇會造成太多副反應(yīng)，不能用于局部病狀。短期服用，它可能還算安全，但是應(yīng)當(dāng)限制使用。對于過敏性鼻炎，抗組織胺劑應(yīng)該是更常用的口服藥。

Soo...what do steroids do? Quite a bit, but in the context of the immune response, they act on white blood cells at the level of their DNA to reduce production of inflammatory cytokines (plus other stuff). They do not directly kill white cells, or frankly any other cells. Again going pretty wild with creative license here. In fact, there is even a transient reaction with steroids in which there is a huge surge of neutrophils in circulation (the marginated pool), it would have been cool to see that.
所以，類固醇是干啥的呢？能干很多事哇，但在免疫反應(yīng)里，它們會對白細(xì)胞的DNA起作用，讓他們減少‘炎癥細(xì)胞因子’的產(chǎn)量。它們不會直接消滅掉白細(xì)胞，也不會消滅別的細(xì)胞。所以這里編劇放飛自我了。其實(shí)嘛，類固醇會產(chǎn)生一種瞬間反應(yīng)，造成大量中性粒細(xì)胞在血液里涌出。如果能畫出這點(diǎn)就好了。

Jesus Christ, it's annihilating EVERYTHING. Steroids have a lot of effects, but they would not cause your mucosa to be torn asunder like this. Remember that these drugs are taken to reduce symptoms... I guess they are depicting this to put the fear of chronic steroid use in you. Seems like this is indeed an orally taken steroid and not a topical. If you want to know what actually happens with chronic steroid overexposure, check out Cushing's syndrome.
天哪嚕，這家伙要滅掉所有人啊。類固醇有許多作用，但他們不會把你的黏膜搞得翻天覆地。還記得吧，這藥是用來減緩癥狀的。。。我估摸著這是嚇唬你，讓你別用慢性激素?？磥磉@還真是口服激素，而不是局部激素。如果你想了解過量服用慢性激素會怎樣的話，請自行查閱‘庫興氏綜合征’。

Summary
總結(jié)


A mild allergic reaction caused by a seasonal pollen. The role of IgE's interplay with mast cells and histamine are nicely characterized, but a lot of creative liberties were taken here to make a complex, multiplayer process more relatable. We finally have some outside intervention being depicted, but I take issue with it.
本集說的是季節(jié)性花粉導(dǎo)致的輕微過敏，很好地體現(xiàn)了‘IgE’和肥大細(xì)胞、組織胺之間的相互作用。但是編劇加入了太多的自由發(fā)揮，估計是想更生動地體現(xiàn)這個復(fù)雜的過程。我們終于看到了外界的干擾因素，但是我覺得表現(xiàn)的并不好。


I'm not a prescribing provider (this month I actually work in the blood bank), but I would not personally prescribe an oral steroid as its effects would be too slow to be helpful in the acute phase and systemic effects too many. A topical nasal steroid spray and/or an antihistamine (diphenhydramine, chlorpheniramine, or the less stupor-inducing second generations like cetirizine, loratadine, and fexofenadine) would be a preferable choice.
我不能開藥方，但是我本身不會開口服的激素，因?yàn)樗乃幮?，對急性病作用不大，而且系統(tǒng)性影響也太多。開局部噴霧劑，或者抗組胺素（苯海拉明，撲爾敏，或者不那么致暈的藥，比如西替利嗪， 氯雷他定，或者鹽酸非索非那定片）應(yīng)該會更好。


Although we are seeing an allergic reaction to this japanese cedar pollen, the same reactions would play out in eg a Ragweed allergy, just with a different IgE targeting a different antigen. The same Type I hypersensitivity is also involved in more serious allergic reactions like anaphylaxis. Those cases would be worth treating not only with steroids but also epinephrine and aggressive airway management.
盡管我們看到的是日本杉樹花粉過敏，但是‘豚草’過敏等也會有類似的反應(yīng)，只不過是不同的IgE攻擊不同的抗原罷了。I型過敏反應(yīng)也會出現(xiàn)在更嚴(yán)重的過敏癥狀中，比如‘全身性過敏反應(yīng)’。這時，不僅需要激素治療，還得用藥物腎上腺素，以及處理呼吸道。

生物類單詞


B-lymphocyte B淋巴細(xì)胞
immune cells 免疫細(xì)胞
macrophage 巨噬細(xì)胞
adaptive immune system 適應(yīng)性免疫系統(tǒng)
stimuli 刺激


antibody 抗體，也叫immunoglobulin 免疫球蛋白，是Y形狀的
antigens 抗原
plasma 血漿


IgA 免疫球蛋白A
mucosal 黏膜的
bone marrow 骨髓
plasma cell 漿細(xì)胞


pollen 花粉
allergy 過敏
CD4+ cells CD4+細(xì)胞，也就是輔助T細(xì)胞
allergen 過敏原
lacrimal duct 淚小管
lymphatic channels 淋巴管


phagocytosis 吞噬作用（把入侵物吃掉）
mast cells 肥大細(xì)胞
basophils 嗜堿性細(xì)胞
allergic response 過敏反應(yīng)


histamine 組織胺
inflammation 發(fā)炎
vascular leakage 血管滲漏
edema 水腫
serum 血清
interstitial fluids 間質(zhì)液
running noses 流鼻子


cytokine 細(xì)胞因子
allergic rhinitis 過敏性鼻炎
vocal cord 聲道
irritation of nerves 神經(jīng)受刺激


steroid 類固醇，激素
orally administered steroid 口服激素


annihilate 消滅
chronic 慢性的
acute 急性的