Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University, Gent, Belgium; First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden.
Department of Otolaryngology, Centre de Recherche du Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2021 Mar;9(3):1099-1106. doi: 10.1016/j.jaip.2020.11.017. Epub 2020 Nov 20.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common and heterogeneous inflammatory disease of the upper respiratory tract. This article provides expert opinion and points of view from both allergists and rhinologists who specialize in CRSwNP. Despite the potential value of biomarker-based endotyping to provide guidance regarding optimal care and treatment choices for patients with CRSwNP, current practice is largely not biomarker-based. In general, there is agreement that for patients with symptomatic CRSwNP who have failed a trial of a course of at least 3 months of intranasal steroids and a short course of oral corticosteroids, a surgical intervention will often be the next treatment of choice. Biologics may be considered before an initial surgery in patients with comorbid severe asthma and in those for whom surgery is less available, refused by the patient, or likely to be associated with a higher-than-average complication rate. Biologic use immediately following surgery may be considered in patients who have a history of nasal polyp recurrence within 12 months of a prior surgery. For many patients with recalcitrant disease, a combination of sinus surgery and use of a biologic that is targeted to their precise endotype may be the optimal treatment strategy, though which surgical approach and which biologics are best for each patient are debates that remain ongoing.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种常见的、异质性的上呼吸道炎症性疾病。本文提供了过敏专家和专攻 CRSwNP 的鼻科医生的专家意见和观点。尽管基于生物标志物的表型分型对于为 CRSwNP 患者提供最佳护理和治疗选择具有潜在价值，但目前的实践在很大程度上并非基于生物标志物。一般来说，对于有症状的 CRSwNP 患者，在经过至少 3 个月的鼻腔类固醇和短期口服皮质类固醇治疗试验后仍未缓解的患者，手术干预通常是下一步的治疗选择。对于伴有严重哮喘的合并症患者，或者对于手术机会较少、患者拒绝手术或手术可能与高于平均水平的并发症发生率相关的患者，在初次手术前可以考虑使用生物制剂。对于既往手术 12 个月内有鼻息肉复发史的患者，术后立即使用生物制剂可能是一种考虑。对于许多顽固疾病患者，鼻窦手术联合针对其特定表型的生物制剂可能是最佳治疗策略，尽管哪种手术方法和哪种生物制剂最适合每个患者仍存在争议。
