Bayar Muluk Nuray, Cingi Cemal, Scadding Glenis K, Scadding Guy
1 Department of Otorhinolaryngology, Kirikkale University, Kirikkale, Turkey.
2 Department of Otorhinolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey.
Am J Rhinol Allergy. 2019 Jan;33(1):83-93. doi: 10.1177/1945892418807590. Epub 2018 Oct 24.
We reviewed the phenotyping and endotyping of chronic rhinosinusitis (CRS) and treatment options.
We searched PubMed, Google, Google Scholar, and the Proquest Central Database of the Kırıkkale University Library.
Phenotypes are observable properties of an organism produced by the environment acting upon the genotype, that is, patients with a particular disorder are subgrouped according to common characteristics. Currently, CRS is usually phenotyped as being with (CRSwNP) or without (CRSsNP) nasal polyps. However, this is not immutable as some individuals progress from nonpolyp to polypoid CRS over time. Phenotypes of CRS are also based on inflammatory patterns, generally CRSwNP is eosinophilic, CRSsNP neutrophilic; but there is a spectrum, rather than a clear-cut division into 2 types. An endotype is a subtype of a condition defined by a distinct functional or pathobiological mechanism. Endotypes of CRS can be (1) nontype Th2, (2) moderate type Th2, and (3) severe type Th2 immune reactions, based on cytokines and mediators such as IL4, 5, 13. CRS endotyping can also include a (1) type 2 cytokine-based approach, (2) eosinophil-mediated approach, (3) immunoglobulin E-based approach, and (4) cysteinyl leukotriene-based approach. Subdivisions of CRSwNP can be made into nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic fungal sinusitis, and eosinophil pauci-granulomatous arteritis by testing. General treatment for all CRS is nasal douching. The place of surgery needs careful reconsideration. Endotype-directed therapies include glucocorticosteroids, antibiotics, aspirin, antifungals, anticytokines, and immunoglobulin replacement. The recognition of united airways and the co-occurrence of CRSwNPs and severe asthma should lead to common endotyping of both upper and lower airways in order to better direct therapy.
Endotyping can allow for the identification of groups of patients with CRS with a high likelihood of successful treatment, such as patients with a moderate type 2 immune reaction or those with acquired immune deficiency.
我们回顾了慢性鼻-鼻窦炎（CRS）的表型分型、内型分型及治疗选择。
我们检索了PubMed、谷歌、谷歌学术以及基利卡莱大学图书馆的Proquest Central数据库。
表型是环境作用于基因型所产生的生物体可观察到的特性，即患有特定疾病的患者根据共同特征被分成亚组。目前，CRS通常根据有无鼻息肉分为有鼻息肉的CRS（CRSwNP）和无鼻息肉的CRS（CRSsNP）。然而，这并非一成不变，因为一些个体随时间推移会从无息肉的CRS进展为息肉样CRS。CRS的表型也基于炎症模式，一般来说，CRSwNP是嗜酸性粒细胞性的，CRSsNP是中性粒细胞性的；但存在一个连续谱，而非明确分为两种类型。内型是由独特的功能或病理生物学机制定义的疾病亚型。基于白细胞介素4、5、13等细胞因子和介质，CRS的内型可以是（1）非2型辅助性T细胞（Th2）型，（2）中度2型Th2型，以及（3）重度2型Th2免疫反应型。CRS内型分型还可包括（1）基于2型细胞因子的方法，（2）嗜酸性粒细胞介导的方法，（3）基于免疫球蛋白E的方法，以及（4）基于半胱氨酰白三烯的方法。通过检测，CRSwNP可细分为非甾体抗炎药加重的呼吸道疾病、变应性真菌性鼻窦炎和嗜酸性粒细胞少的肉芽肿性血管炎。所有CRS的一般治疗方法是鼻腔冲洗。手术的地位需要仔细重新考量。基于内型的治疗包括糖皮质激素、抗生素、阿司匹林、抗真菌药、抗细胞因子药物和免疫球蛋白替代治疗。认识到上、下呼吸道联合以及CRSwNP与重度哮喘的共存情况，应促使对上、下呼吸道进行共同的内型分型，以便更好地指导治疗。
内型分型有助于识别CRS患者中治疗成功可能性高的群体，如中度2型免疫反应患者或获得性免疫缺陷患者。
