山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (3): 4-9.doi: 10.6040/j.issn.1673-3770.1.2018.004

• 慢性鼻窦炎鼻息肉临床实践专题笔谈 • 上一篇    下一篇


李华斌, 赖玉婷   

  1. 复旦大学附属眼耳鼻喉科医院耳鼻喉科, 上海 200031
  • 收稿日期:2018-02-20 出版日期:2018-05-20 发布日期:2018-05-20
  • 通讯作者: 李华斌. E-mail:noseli@163.com
  • 基金资助:

Pathogenesis, diagnosis, and treatment of chronic rhinosinusitis

LI Huabin, LAI Yuting   

  1. Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
  • Received:2018-02-20 Online:2018-05-20 Published:2018-05-20

摘要: 慢性鼻-鼻窦炎(CRS)是耳鼻咽喉头颈外科的多因素疾病。根据患者症状、鼻内镜检查以及鼻窦CT扫描,CRS的诊断比较明确,但其病理机制却较复杂,治疗方式的选择也不完全一样。临床上应该更多地考虑内在的病理机制类型,采取针对性的治疗方式,以达到最好的治疗效果。

关键词: 发病机制, 糖皮质激素, 慢性, 鼻息肉, 鼻内镜外科手术, 鼻-鼻窦炎

Abstract: Chronic rhinosinusitis(CRS)is a multifactorial otolaryngologic disease, often requiring surgical intervention. The diagnosis of CRS is relatively clear based on the patients symptoms, and nasal endoscopy and sinus CT scan findings. However, the pathogenesis is complex with multiple treatment methods. Hence, the type of intrinsic pathologic mechanism and its target treatment method should be given greater consideration, in order to achieve the best therapeutic effects.

Key words: Rhinosinusitis, chronic, Nasal polyps, Pathological mechanism, Nasal surgical procedures, operative, Glucocorticoids


  • R765.4
[1] Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012[J]. Rhinol Suppl, 2012, 23:3 p preceding table of contents, 1-298.
[2] Kato A. Immunopathology of chronic rhinosinusitis[J]. Allergol Int, 2015, 64(2):121-130.
[3] Steinke JW, Borish L. Chronic rhinosinusitis phenotypes[J]. Ann Allergy Asthma Immunol, 2016, 117(3):234-240.
[4] Cho SW, Kim DW, Kim JW, et al. Classification of chronic rhinosinusitis according to a nasal polyp and tissue eosinophilia: limitation of current classification system for Asian population[J]. Asia Pac Allergy, 2017, 7(3):121-130.
[5] Wang X, Zhang N, Bo M, et al. Diversity of TH cytokine profiles in patients with chronic rhinosinusitis: a multicenter study in europe, asia, and oceania[J]. J Allergy Clin Immunol, 2016, 138(5):1344-1353.
[6] Maxfield AZ, Landegger LD, Brook CD, et al. Periostin as a biomarker for nasal polyps in chronic rhinosinusitis[J]. Otolaryngol Head Neck Surg, 2018, 158(1):181-186.
[7] Jonstam K, Westman M, Holtappels G, et al. Serum periostin, ige, and se-ige can be used as biomarkers to identify moderate to severe chronic rhinosinusitis with nasal polyps[J]. J Allergy Clin Immun, 2017, 140(6):1705-1708.
[8] Van Zele T, Claeys S, Gevaert P, et al. Differentiation of chronic sinus diseases by measurement of inflammatory mediators[J]. Allergy, 2006, 61(11):1280-1289.
[9] Van Crombruggen K, Zhang N, Gevaert P, et al. Pathogenesis of chronic rhinosinusitis: inflammation[J]. J Allergy Clin Immunol, 2011, 128(4):728-732.
[10] Payne SC, Early SB, Huyett P, et al. Evidence for distinct histologic profile of nasal polyps with and without eosinophilia[J]. Laryngoscope, 2011, 121(10):2262-2267.
[11] Van Bruaene N, Derycke L, Perez-Novo CA, et al. Tgf-beta signaling and collagen deposition in chronic rhinosinusitis[J]. J Allergy Clin Immunol, 2009, 124(2):253-259.
[12] Takabayashi T, Kato A, Peters AT, et al. Excessive fibrin deposition in nasal polyps caused by fibrinolytic impairment through reduction of tissue plasminogen activator expression[J]. Am J Respir Crit Care Med, 2013, 187(1):49-57.
[13] Kato A. Immunopathology of chronic rhinosinusitis[J]. Allergol Int, 2015, 64(2):121-130.
[14] Klimek L, Koennecke M, Mullol J, et al. A possible role of stem cells in nasal polyposis[J]. Allergy, 2017, 72(12):1868-1873.
[15] Yu XM, Li CW, Chao SS, et al. Reduced growth and proliferation dynamics of nasal epithelial stem/progenitor cells in nasal polyps in vitro[J]. Sci Rep, 2014, 4:4619. DOI:10.1038/srep04619.
[16] Pezato R, de Almeida DC, Bezerra TF, et al. Immunoregulatory effects of bone marrow-derived mesenchymal stem cells in the nasal polyp microenvironment[J]. Mediators Inflamm, 2014, 2014:583409. DOI:10.1155/2014/583409.
[17] Cho KS, Kim YW, Kang MJ, et al. Immunomodulatory effect of mesenchymal stem cells on T lymphocyte and cytokine expression in nasal polyps[J]. Otolaryngol Head Neck Surg, 2014, 150(6):1062-1070.
[18] Ho J, Bailey M, Zaunders J, et al. Group 2 innate lymphoid cells(ilc2s)are increased in chronic rhinosinusitis with nasal polyps or eosinophilia[J]. Clin Exp Allergy, 2015, 45(2):394-403.
[19] Lam M, Hull L, Imrie A, et al. Interleukin-25 and interleukin-33 as mediators of eosinophilic inflammation in chronic rhinosinusitis[J]. Am J Rhinol Allergy, 2015, 29(3):175-181.
[20] Shin HW, Kim DK, Park MH, et al. Il-25 as a novel therapeutic target in nasal polyps of patients with chronic rhinosinusitis[J]. J Allergy Clin Immunol, 2015, 135(6):1476-1485.
[21] Bachert C, Gevaert E. Advances in rhinitis and rhinosinusitis in 2015[J]. J Allergy Clin Immunol, 2016, 138(5):1277-1283.
[22] Mullol J, Obando A, Pujols L, et al. Corticosteroid treatment in chronic rhinosinusitis: the possibilities and the limits[J]. Immunol Allergy Clin North Am, 2009, 29(4):657-668.
[23] Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: chritical review and surgical considerations[J]. Laryngoscope, 2004, 114(2):255-265.
[24] Koay B, Bates G, Elston J. Endoscopic orbital decompression for dysthyroid eye disease[J]. J Laryngol Otol, 1997, 111(10):946-949.
[25] Wigand ME, Hosemann WG. Results of endoscopic surgery of the paranasal sinuses and anterior skull base[J]. J Otolaryngol, 1991, 20(6):385-390.
[26] Bachert C, Akdis CA. Phenotypes and emerging endotypes of chronic rhinosinusitis[J]. J Allergy Clin Immunol Pract, 2016, 4(4):621-628.
[27] Stevens WW, Ocampo CJ, Berdnikovs S, et al. Cytokines in chronic rhinosinusitis role in eosinophilia and aspirin-exacerbated respiratory disease[J]. Am J Respir Crit Care Med, 2015, 192(6):682-694.
[28] Yoo F, Ference EH, Kuan EC, et al. Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery[J]. Int Forum Allergy Rhinol, 2018, 8(1):32-40.
[29] Rezaeian A. Outcome of spray cryotherapy plus functional endoscopic sinus surgery on management of healing in nasal polyposis[J] Am J Otolaryngol, 2018, 39(1):10-13.
[30] Chen JN, Wang X, Chen LZ, et al. Influence of hyaluronan nasal dressing on clinical outcome after endoscopic sinus surgery: a systematic review and meta-analysis[J]. Am J Rhinol Allergy, 2017, 31(4):256-259.
[31] Lou H, Meng Y, Piao Y, et al. Predictive significance of tissue eosinophilia for nasal polyp recurrence in the chinese population[J]. Am J Rhinol Allergy, 2015, 29(5):350-356.
[32] Van Zele T, Holtappels G, Gevaert P, et al. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps[J]. Am J Rhinol Allergy, 2014, 28(3):192-198.
[33] Ramakrishnan VR, Hauser LJ, Feazel LM, et al. Sinus microbiota varies among chronic rhinosinusitis phenotypes and predicts surgical outcome[J]. J Allergy Clin Immunol, 2015, 136(2):334-342.
[34] Kennedy JL, Hubbard MA, Huyett P, et al. Sino-nasal outcome test(snot-22): a predictor of postsurgical improvement in patients with chronic sinusitis[J]. Ann Allergy Asthma Immunol, 2013, 111(4):246-251.
[35] Dautremont JF, Rudmik L. When are we operating for chronic rhinosinusitis? A systematic review of maximal medical therapy protocols prior to endoscopic sinus surgery[J]. Int Forum Allergy Rhinol, 2015, 5(12):1095-1103.
[36] Sylvester DC, Carr S, Nix P. Maximal medical therapy for chronic rhinosinusitis: a survey of otolaryngology consultants in the united kingdom[J]. Int Forum Allergy Rhinol, 2013, 3(2):129-132.
[37] Schwartz JS, Tajudeen BA, Cohen NA. Medical management of chronic rhinosinusitis-an update[J]. Expert Rev Clin Pharmacol, 2016, 9(5):695-704.
[38] Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: rhinosinusitis[J]. Int Forum Allergy Rhinol, 2016, 6(Suppl 1):22-209. DOI:10.1002/air.21695.
[39] Chong LY, Head K, Hopkins C, et al. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis[J]. Cochrane Database Syst Rev, 2016, 4. DOI: 10. 1002/14651858.
[40] Head K, Chong LY, Hopkins C, et al. Short-course oral steroids alone for chronic rhinosinusitis[J]. Cochrane Database Syst Rev, 2016, 4. DOI: 10. 1002/14651858.
[41] Poetker DM, Reh DD. A comprehensive review of the adverse effects of systemic corticosteroids[J]. Otolaryngol Clin North Am, 2010, 43(4):753-768.
[42] Soler ZM, Oyer SL, Kern RC, et al. Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidenced-based review with recommendations[J]. Int Forum Allergy Rhinol, 2013, 3(1):31-47.
[43] Oakley GM, Harvey RJ, Lund VJ. The role of macrolides in chronic rhinosinusitis(crssnp and crswnp)[J]. Curr Allergy Asthma Rep, 2017, 17(5):30.
[44] Lee JT, Chiu AG. Topical anti-infective sinonasal irrigations: update and literature review[J]. Am J Rhinol Allergy, 2014, 28(1):29-38.
[45] Bachert C, Mannent L, Naclerio RM, et al. Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis:a randomized clinical trial[J]. JAMA, 2016, 315(5):469-479.
[46] Gevaert P, Calus L, Van Zele T, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma[J]. J Allergy Clin Immunol, 2013, 131(1):110-116.
[47] Gevaert P, Lang-Loidolt D, Lackner A, et al. Nasal il-5 levels determine the response to anti-il-5 treatment in patients with nasal polyps[J]. J Allergy Clin Immunol, 2006, 118(5):1133-1141.
[48] Sivasubramaniam R, Harvey RJ. How to assess, control, and manage uncontrolled crs/nasal polyp patients[J]. Curr Allergy Asthma Rep, 2017, 17(9):58.
[1] 宋晓宇, 张宇, 李成林, 宋西成. 加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 9-12.
[2] 吴喜福, 孔维封, 王玮豪, 徐惠清, 戚敏, 杨钦泰. QoR-15在加速康复外科改善慢性鼻-鼻窦炎伴鼻息肉围手术期生活质量评估中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 5-8.
[3] 乔叔芬,杨飞轮,王臻妮,李学忠. YKL-40与慢性鼻-鼻窦炎组织重构的相关性探讨[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 95-99.
[4] 黄远,巴罗,李波,余文兴,杨芳丽,杜进涛. 慢性鼻窦炎鼻息肉中转录因子NKX2-1调控嗜酸性炎症反应的作用[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 17-23.
[5] 陈望兴,赵雪,刘岩,刘悦,金春顺. 鼻中隔偏曲及慢性鼻窦炎鼻息肉患者的精神心理状态调查[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 24-27.
[6] 黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31.
[7] 张桂敏,林鹏. 慢性鼻-鼻窦炎的内在型:从基础到临床[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 14-17.
[8] 陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[9] 娄鸿飞,王成硕. 慢性鼻窦炎分型研究进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 10-13.
[10] 张炜,曾昱菡,余先崧. 慢性鼻窦炎手术前后ECP、EGF、IL-6的水平变化及临床意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 63-67.
[11] 于倩倩,关鸽,张念凯,李娜,温君凤,刘婷婷,连媛媛. 鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的CT影像表现[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 76-81.
[12] 李莹. 慢性鼻窦炎的辨证论治[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 27-30.
[13] 李宏梅,王兰,高照慧,王莹,薛金梅. p-ERK2及ERK2在鼻息肉组织的表达及其意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 42-46.
[14] 张劼,龚齐. 不同分型慢性鼻-鼻窦炎患者外周血嗜酸性粒细胞与中性粒细胞百分比及变态反应临床差异性分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 54-57.
[15] 甘彬,张永举,许安廷. BRF2在慢性鼻-鼻窦炎伴鼻息肉发病过程中的作用研究[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 47-53.
Full text



No Suggested Reading articles found!