Department of Otorhinolaryngology, Yokohama City University Medical Center Graduate School of Medicine, Kanagawa, Japan..
Department of Otorhinolaryngology, Yokohama City University Medical Center Graduate School of Medicine, Kanagawa, Japan.
Allergol Int. 2010 Sep;59(3):239-245. doi: 10.2332/allergolint.10-RAI-0231. Epub 2010 Jul 25.
Chronic rhinosinusitis is a heterogeneous disease. In Europe and the United States, it has recently been divided into two subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). The majority of CRSwNP cases have a strong tendency to recur after surgery and show eosinophil-dominant inflammation. However, this definition has proved difficult to apply in Japan and East Asia, because more than half of the CRSwNP cases do not exhibit eosinophil-dominant inflammation in these areas of the world. In Japan in the 1990s, refractory CRSwNP to the standard treatment was focused on in clinical studies and the term "eosinophilic chronic rhinosinusitis" (ECRS) was introduced to identify this subgroup of chronic rhinosinusitis in 2001. ECRS is different from non-ECRS in terms of many clinical features: symptom appearance, occurrence site of nasal polyps, CT scan findings, the histology of nasal polyps, blood examination findings, clinical course after surgery, and co-morbid asthma, etc. In this review, we describe these clinical features and mention how to make a clinical diagnosis of ECRS as well as how to treat it. Finally, we discuss the pathophysiology of ECRS. The concept of ECRS in Japan would be applicable for CRSwNP in other countries including Europe and the United States.
慢性鼻-鼻窦炎是一种异质性疾病。在欧洲和美国，它最近被分为两个亚组：伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）和不伴鼻息肉的慢性鼻-鼻窦炎（CRSsNP）。大多数 CRSwNP 病例在手术后有很强的复发倾向，并表现出以嗜酸性粒细胞为主的炎症。然而，这一定义在日本和东亚已经被证明难以适用，因为在这些地区，超过一半的 CRSwNP 病例并不表现出以嗜酸性粒细胞为主的炎症。在 20 世纪 90 年代的日本，针对标准治疗的难治性 CRSwNP 成为临床研究的重点，并且在 2001 年引入了“嗜酸性慢性鼻-鼻窦炎”（ECRS）这个术语来识别这组慢性鼻-鼻窦炎。ECRS 在许多临床特征方面与非 ECRS 不同：症状表现、鼻息肉发生部位、CT 扫描结果、鼻息肉的组织学、血液检查结果、手术后的临床病程以及合并哮喘等。在这篇综述中，我们描述了这些临床特征，并提到了如何做出 ECRS 的临床诊断以及如何治疗它。最后，我们讨论了 ECRS 的病理生理学。日本的 ECRS 概念也适用于包括欧洲和美国在内的其他国家的 CRSwNP。
