基于表型和内在型的慢性鼻窦炎诊治进展

doi:10.6040/j.issn.1673-3770.0.2022.034

摘要/Abstract

摘要： 慢性鼻窦炎(CRS)是一种具有复杂表型和内在型的异质性疾病。根据是否有鼻息肉,CRS的表型可分为伴或不伴息肉。CRS的其他表型分类还包括是否伴有过敏、哮喘、阿司匹林不耐受等。近年来,关于CRS内在型致病机制的研究如2型炎症和非2型炎症取得突破性进展,为CRS的治疗引入了有效的生物制剂。阐述慢性鼻窦炎最新表型和内在型分类和基于表型和内在型的最新治疗进展,为临床更好地结合内在型和表型,对慢性鼻窦炎更精确的诊断和更精准的个性化治疗提供思路。

关键词: 慢性鼻窦炎, 表型, 内在型, 诊断, 治疗

Abstract: Chronic rhinosinusitis(CRS)is a heterogeneous disease with complex phenotypes and endotypes. Depending on the presence or absence of nasal polyps, CRS phenotypes can be classified as with or without polyps. Other phenotypic classifications of CRS include allergies, asthma, and aspirin intolerance. In recent years, breakthroughs have been made in research on the pathogenesis of CRS endotypes, such as type 2 inflammation and non-type 2 inflammation, and effective biological agents have been introduced for the treatment of CRS. This article describes the latest phenotype and endotype classification of chronic rhinosinusitis and the latest treatment progress based on phenotypes and endotypes. The identification of specific endotype and phenotype combinations will allow more accurate diagnoses of chronic rhinosinusitis and personalized treatments in the future.

Key words: Chronic sinusitis, Phenotype, Endotype, Diagnosis, Treatment

中图分类号:

R765

熊攀辉,沈暘,杨玉成. 基于表型和内在型的慢性鼻窦炎诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 15-19.

XIONG Panhui, SHEN Yang,YANG Yucheng. Advancements in the diagnosis and treatment of chronic sinusitis based on phenotypes and endotypes[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 15-19.

参考文献

[1] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600.
[2] DeConde AS, Soler ZM. Chronic rhinosinusitis: Epidemiology and burden of disease[J]. Am J Rhinol Allergy, 2016, 30(2): 134-139. doi:10.2500/ajra.2016.30.4297.
[3] Yim MT, Orlandi RR. Evolving rhinology: understanding the burden of chronic rhinosinusitis today, tomorrow, and beyond[J]. Curr Allergy Asthma Rep, 2020, 20(3): 7. doi:10.1007/s11882-020-00904-w.
[4] Rudmik L. Economics of chronic rhinosinusitis[J]. Curr Allergy Asthma Rep, 2017, 17(4): 20. doi:10.1007/s11882-017-0690-5.
[5] Cho SH, Ledford D, Lockey RF. Medical management strategies in acute and chronic rhinosinusitis[J]. J Allergy Clin Immunol Pract, 2020, 8(5): 1559-1564. doi:10.1016/j.jaip.2020.02.020.
[6] Ahern S, Cervin A. Inflammation and endotyping in chronic rhinosinusitis-A paradigm shift[J]. Medicina(Kaunas), 2019, 55(4): E95. doi:10.3390/medicina55040095.
[7] Xu XN, Ong YK, Wang DY. Novel findings in immunopathophysiology of chronic rhinosinusitis and their role in a model of precision medicine[J]. Allergy, 2020, 75(4): 769-780. doi:10.1111/all.14044.
[8] Grayson JW, Hopkins C, Mori ER, et al. Contemporary classification of chronic rhinosinusitis beyond polyps vs no polyps: a review[J]. JAMA Otolaryngol Head Neck Surg, 2020, 146(9): 831-838. doi:10.1001/jamaoto.2020.1453.
[9] Lou HF, Wang CS, Zhang L. Endotype-driven precision medicine in chronic rhinosinusitis[J]. Expert Rev Clin Immunol, 2019, 15(11): 1171-1183. doi:10.1080/1744666X.2020.1679626.
[10] 毛弈友, 陈杰, 廖敏, 等. 慢性鼻窦炎相关内在型分类及血液标志物的研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2020, 26(3): 338-342. doi:10.11798/j.issn.1007-1520.202003024. MAO Yiyou, CHEN Jie, LIAO Min, et al. Research progress on blood markers and endotypes classification of chronic rhinosinusitis[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2020, 26(3): 338-342. doi:10.11798/j.issn.1007-1520.202003024.
[11] Yip J, Monteiro E, Chan Y. Endotypes of chronic rhinosinusitis[J]. Curr Opin Otolaryngol Head Neck Surg, 2019, 27(1): 14-19. doi:10.1097/moo.0000000000000503.
[12] Cao PP, Wang ZC, Schleimer RP, et al. Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes[J]. Ann Allergy Asthma Immunol, 2019, 122(1): 33-40. doi:10.1016/j.anai.2018.10.014.
[13] Yang Y, Zhang N, Lan F, et al. Transforming growth factor-beta 1 pathways in inflammatory airway diseases[J]. Allergy, 2014, 69(6): 699-707. doi:10.1111/all.12403.
[14] Ahern S, Cervin A. Inflammation and endotyping in chronic rhinosinusitis-A paradigm shift[J]. Medicina(Kaunas), 2019, 55(4): E95. doi:10.3390/medicina55040095.
[15] Wang XD, Zhang N, Bo MY, 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. doi:10.1016/j.jaci.2016.05.041.
[16] Ma J, Shi LL, Deng YK, et al. CD8(+)T cells with distinct cytokine-producing features and low cytotoxic activity in eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps[J]. Clin Exp Allergy, 2016, 46(9): 1162-1175. doi:10.1111/cea.12758.
[17] 冯丹丹, 黄江菊, 柯霞, 等. 焦虑抑郁程度与慢性鼻窦炎内镜术后主观症状改善的相关性研究[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(9): 830-836. doi:10.3760/cma.j.cn115330-20200327-00249. FENG Dandan, HUANG Jiangju, KE Xia, et al. The correlation between the degree of anxiety/depression and the improvement of subjective and objective symptoms after functional endoscopic sinus surgery in chronic sinusitis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(9): 830-836. doi:10.3760/cma.j.cn115330-20200327-00249.
[18] 刘勃, 张振华, 高爱民. 探讨鼻腔、鼻窦解剖异常与慢性鼻窦炎的相关性[J]. 山东大学耳鼻喉眼学报, 2012, 26(6): 41-43. LIU Bo, ZHANG Zhenhua, GAO Aimin. Relationship between anatomic abnormality of the nasal cavity and the nasal sinus and chronic sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2012, 26(6): 41-43.
[19] 李静, 施心怡, 杨瑶, 等. 慢性鼻窦炎的临床病理与预后关系的探讨[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 914-919. doi:10.13201/j.issn.2096-7993.2021.10.011. LI Jing, SHI Xinyi, YANG Yao, et al. The relationship between clinical pathology and prognosis of chronic rhinosinusitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(10): 914-919. doi:10.13201/j.issn.2096-7993.2021.10.011.
[20] 李双, 廖敏, 刘江怡, 等. 嗜酸性粒细胞在鼻息肉发病中的作用及机制研究[J]. 中国耳鼻咽喉头颈外科, 2019, 26(12): 664-667. doi:10.16066/j.1672-7002.2019.12.008. LI Shuang, LIAO Min, LIU Jiangyi, et al. Study on the role and mechanism of eosinophils in the pathogenesis of nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(12): 664-667. doi:10.16066/j.1672-7002.2019.12.008.
[21] 肖玲, 姚红兵, 杨玉成. 主客观评估对慢性鼻-鼻窦炎患者围手术期鼻塞的指导作用[J]. 中国耳鼻咽喉头颈外科, 2018, 25(3): 139-142. doi:10.16066/j.1672-7002.2018.03.008. XIAO Ling, YAO Hongbing, YANG Yucheng. Guidine role of sunjective and objective assessment in chronic rhinosinusitis patient with nasal congestion during perioperative period[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2018, 25(3): 139-142. doi:10.16066/j.1672-7002.2018.03.008.
[22] 陈杰, 毛弈友, 陈卓, 等. Ⅱ型炎症在慢性鼻窦炎伴鼻息肉中的作用机制和治疗进展[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 993-997. doi:10.3760/cma.j.cn115330-20200813-00671. CHEN Jie, MAO Yiyou, CHEN Zhuo, et al. Research progress on the role of type Ⅱ inflammation in chronic rhinosinusitis with polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(10): 993-997. doi:10.3760/cma.j.cn115330-20200813-00671.
[24] Gevaert P, Omachi TA, Corren J, et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials[J]. J Allergy Clin Immunol, 2020, 146(3): 595-605. doi:10.1016/j.jaci.2020.05.032.
[25] Han JK, Bachert C, Fokkens W, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps(SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet Respir Med, 2021, 9(10): 1141-1153. doi:10.1016/S2213-2600(21)00097-7.
[26] 王成硕, 张罗. 慢性鼻窦炎伴鼻息肉诊疗迈入精准治疗时代[J]. 中国耳鼻咽喉头颈外科, 2019, 26(12): 635-638. doi:10.16066/j.1672-7002.2019.12.001. WANG Chengshuo, ZHANG Luo. Precision medicine for chronic rhinosinusitis with nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(12): 635-638. doi:10.16066/j.1672-7002.2019.12.001.
[27] 邹璨, 杨玉成. 鼻内镜扩大鼻窦开放术研究进展[J]. 国际耳鼻咽喉头颈外科杂志, 2019, 43(4): 230-233. doi:10.3760/cma.j.issn.1673-4106.2019.04.011. ZOU Can, YANG Yucheng. Progress of extended endoscopic sinus surgery[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2019, 43(4): 230-233. doi:10.3760/cma.j.issn.1673-4106.2019.04.011.
[28] DeConde AS, Soler ZM. Chronic rhinosinusitis: Epidemiology and burden of disease[J]. Am J Rhinol Allergy, 2016, 30(2): 134-139. doi:10.2500/ajra.2016.30.4297.
[29] Mendelsohn D, Jeremic G, Wright ED, et al. Revision rates after endoscopic sinus surgery: a recurrence analysis[J]. Ann Otol Rhinol Laryngol, 2011, 120(3): 162-166. doi:10.1177/000348941112000304.
[30] Eloy JA, Marchiano E, Vázquez A. Extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis[J]. Otolaryngol Clin North Am, 2017, 50(1): 165-182. doi:10.1016/j.otc.2016.08.013.
[31] Alsharif S, Jonstam K, van Zele T, et al. Endoscopic sinus surgery for type-2 CRS wNP: an endotype-based retrospective study[J]. Laryngoscope, 2019, 129(6): 1286-1292. doi:10.1002/lary.27815.
[32] 杨玉成, 邹璨. 慢性鼻-鼻窦炎伴鼻息肉的手术治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(5): 328-331. doi:10.13201/j.issn.1001-1781.2018.05.003. YANG Yucheng, ZOU Can. Surgical treatment of cronic rhinosinusitis with nasal polyps[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(5): 328-331. doi:10.13201/j.issn.1001-1781.2018.05.003.

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