Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China.
Upper Airways Research Laboratory, Ghent University, Ghent, Belgium.
Nat Rev Dis Primers. 2020 Oct 29;6(1):86. doi: 10.1038/s41572-020-00218-1.
Chronic rhinosinusitis (CRS) occurs in >10% of the adult population in Europe and the USA and can be differentiated into CRS without nasal polyps and CRS with nasal polyps (CRSwNP). Both phenotypes are characterized by a high disease burden and an overlapping spectrum of symptoms, with facial pain and loss of smell being the most differentiating. Great progress has been made in the understanding of CRS pathophysiology: from the epithelium and epithelial-mesenchymal transition to innate and adaptive immunity pathways and, finally, on the role of eosinophils and Staphylococcus aureus in the persistence of disease. Although clinical manifestations and diagnostic tools (including nasal endoscopy and imaging) have undergone major changes over the past few years, management (including pharmacotherapy, surgery and biologics) has experienced enormous progress based on the growing knowledge of key mediators in severe CRSwNP. The introduction of endotyping has led to a differentiation of 'tailored' surgical approaches, focusing on the mucosal concept in those with severe CRSwNP and on the identification of patients eligible for extended surgery and possibly biologics in the future.
慢性鼻-鼻窦炎（CRS）在欧洲和美国的成年人群中发生率超过 10%，可分为伴有鼻息肉的 CRS（CRSwNP）和不伴有鼻息肉的 CRS（CRSNP）。这两种表型均具有较高的疾病负担和重叠的症状谱，其中面部疼痛和嗅觉丧失是最具鉴别意义的症状。人们对 CRS 病理生理学的认识已经取得了很大的进展：从上皮细胞和上皮-间充质转化，到先天和适应性免疫途径，最后是嗜酸性粒细胞和金黄色葡萄球菌在疾病持续存在中的作用。尽管近年来临床表现和诊断工具（包括鼻内镜和影像学）发生了重大变化，但基于对严重 CRSwNP 中关键介质的认识不断深入，其治疗（包括药物治疗、手术和生物制剂）已经取得了巨大的进展。内表型的引入导致了“量身定制”手术方法的分化，在严重 CRSwNP 患者中强调黏膜概念，并确定未来适合扩展手术和可能使用生物制剂的患者。
