慢性鼻-鼻窦炎与全身性糖皮质激素应用

Classification and systemic glucocorticoids in the treatment of chronic rhinosinusitis

慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)是涉及一个或几个鼻窦的黏膜炎性病变,是重要的医疗问题。CRS分为慢性鼻-鼻窦炎伴或不伴鼻息肉。中国CRS发病率约为2.2%,低于欧美国家(5%~15%)。CRS不伴鼻息肉有Th1倾向性,转化生长因子-β在其发病过程中起重要作用。CRS伴鼻息肉有Th2偏向性,嗜酸性粒细胞、Th2型淋巴样细胞等炎性细胞及各类Th2介质共同起作用。CRS伴或不伴鼻息肉患者均推荐使用鼻用糖皮质激素。CRS伴鼻息肉尤其是严重、复发性鼻息肉患者,推荐使用全身性糖皮质激素;CRS不伴鼻息肉及儿童患者不推荐使用全身性糖皮质激素。

Chronic Rhinosinusitis (CRS) is an inflammatory disease of the mucous membrane involving one or more sinuses, and also it is an important medical problem. CRS is classified as chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP). The incidence of CRS in China is about 2.2%, which is lower than that in Europe and the United States (5% to 15%). CRSsNP shows Th 1 -type inflammation, and transforming growth factor-p (TGF-p) plays an important role in the pathogenesis of CRSsNP. Eosinophils, other inflammatory cells and Th2 inflammatory factors are participate in the disease of CRSwNP which performed Th2 inflammation.Nasal glucocorticoids are recommended for patients with CRSsNP and CRSwNP. Systemic glucocorticoids are recommended for CRSwNP, especially patients with severe or recurrent nasal polyps. Adults and children with CRSsNP are not recommended for systemic glucocorticoids.