Cho Seong H, Ledford Dennis, Lockey Richard F
Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla.
Division of Allergy-Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla.
J Allergy Clin Immunol Pract. 2020 May;8(5):1559-1564. doi: 10.1016/j.jaip.2020.02.020. Epub 2020 Mar 3.
Chronic rhinosinusitis, historically, has been considered to be caused by upper airway anatomical abnormalities. However, today that concept has changed, for it is now recognized as an inflammatory disorder of the nasal and sinus mucosa. Acute rhinosinusitis is usually caused by a viral infection, whereas chronic rhinosinusitis is a persistent and heterogeneous inflammatory disorder with increased expression of type 1, 2, or 17 cytokines in the nasal and sinus mucosa, similar to that which occurs in asthma. Exacerbations are caused by aeroallergens in the allergic individual and irritants, pollutants, and viral/bacterial infections in all subjects. It may be categorized by phenotypes, examples of which include chronic rhinosinusitis with nasal polyps or chronic rhinosinusitis without nasal polyps. Defined endotypes are based on underlying pathophysiological mechanisms. Knowledge of chronic rhinosinusitis endotypes will optimize management by employing targeted medical therapies. Understanding that rhinosinusitis is a heterogeneous inflammatory disease has led to the identification of a variety of different predisposing conditions, new medical treatment options, and the concept that rhinosinusitis is primarily a medical problem.
从历史上看，慢性鼻窦炎一直被认为是由上呼吸道解剖结构异常引起的。然而，如今这一观念已经改变，因为现在它被认为是一种鼻腔和鼻窦黏膜的炎症性疾病。急性鼻窦炎通常由病毒感染引起，而慢性鼻窦炎是一种持续且异质性的炎症性疾病，鼻腔和鼻窦黏膜中1型、2型或17型细胞因子的表达增加，这与哮喘中发生的情况类似。在过敏个体中，病情加重是由气传变应原引起的，而在所有患者中，刺激物、污染物以及病毒/细菌感染都会导致病情加重。它可以根据表型进行分类，其中包括伴有鼻息肉的慢性鼻窦炎或不伴有鼻息肉的慢性鼻窦炎。明确的内型是基于潜在的病理生理机制。了解慢性鼻窦炎内型将通过采用有针对性的药物治疗来优化管理。认识到鼻窦炎是一种异质性炎症性疾病，已经导致了对各种不同易感因素的识别、新的药物治疗选择以及鼻窦炎主要是一个医学问题的观念。
