以慢性鼻窦炎内在型为导向的临床治疗选择

Clinical treatment options oriented to the endotype of chronic rhinosinusitis

慢性鼻窦炎(chronic rhinosinusitis,CRS)是累及鼻窦黏膜超过12周的炎性疾病,根据临床表型是否合并鼻息肉(nasalpolyp,NP),可以分为CRSwNP和CRSsNP2种。临床发现,相似临床表型患者的疾病预后和生活质量改善存在明显差异。炎症细胞浸润和免疫炎症介质是CRS内型驱动的重要因素,其中,尤以嗜酸性粒细胞浸润的2型CRS的疾病严重程度、并发症、治疗高复发率和较低生活质量成为CRS治疗的难点。以CRS内型为导向的治疗方法可能更有助于患者的预后和生活质量的提高。本文总结目前CRS内型研究的进展和以内型为导向的治疗选择展开综述。

Chronic rhinosinusitis(CRS)is an inflammatory disease involving the mucosa of the nasal and paranasal sinuses for more than 12 weeks and can be classified as CRS with nasal polyp(CRSwNP)and CRS without nasal polyp(CRSsNP)depending on the phenotype.Clinical treatments reveal significant differences in disease prognosis and improvement in quality of life in patients with the same clinical phenotype.Inflammatory cells infiltration and inflammatory mediators are important factors driving CRS endotypes.In particular,CRS with predominantly eosinophilic infiltration and type 2 CRS present severe clinical symptoms,comorbidities,and high recurrence rates.CRS endotype-oriented treatment methods may better contribute to improving patient prognosis and quality of life.This article summarizes the current progress of CRS endotype research and reviews the endotype-oriented treatment options.