Moiseeva Yu P, Piskunov G Z
Russian Medical Academy for Continuous Professional Education, Moscow, Russia.
Vestn Otorinolaringol. 2022;87(3):40-45. doi: 10.17116/otorino20228703140.
Due to the high recurrence rate and the variety of complex pathogenesis mechanisms, chronic rhinosinusitis with nasal polyps is difficult to treat. In addition, the disease reduces the quality of life of patients and carries a large financial burden on the healthcare system, therefore, a personalized approach to the treatment of this pathology is becoming popular today. In order to determine which drug route would be most rational for a particular patient, key concepts such as phenotyping, endotyping and genotyping of chronic rhinosinusitis with nasal polyps were introduced. This approach has expanded the understanding of the etiological aspects of the disease and the pathogenetic mechanisms of the formation of nasal polyps. In this regard, immunotherapy of chronic rhinosinusitis with nasal polyps began to develop, consisting in the use of monoclonal antibodies to the substrates of the immune system, which are key figures in the development of certain types of inflammatory reactions of the mucous membrane of the nasal cavity and paranasal sinuses. The use of biological agents represents the first steps in targeted therapy, which is a transition to personalized treatment of patients with chronic rhinosinusitis with nasal polyps. Further studies in the field of immunological mechanisms of the formation of various phenotypes of chronic rhinosinusitis with nasal polyps from the standpoint of proteinomics, transcriptomics and epigenetics give hope for the development of a new drug-based treatment for this disease, which can significantly reduce the need for surgical treatment of patients with this pathology.
由于鼻息肉慢性鼻窦炎的高复发率和多种复杂的发病机制，其治疗较为困难。此外，该疾病降低了患者的生活质量，并给医疗系统带来巨大经济负担，因此，针对这种病症的个性化治疗方法如今正变得流行起来。为了确定哪种给药途径对特定患者最为合理，引入了鼻息肉慢性鼻窦炎的表型分析、内型分析和基因分型等关键概念。这种方法扩展了对该疾病病因方面以及鼻息肉形成的发病机制的理解。在这方面，鼻息肉慢性鼻窦炎的免疫疗法开始发展，包括使用针对免疫系统底物的单克隆抗体，这些底物是鼻腔和鼻窦黏膜某些类型炎症反应发展中的关键因素。生物制剂的使用代表了靶向治疗的第一步，这是向鼻息肉慢性鼻窦炎患者个性化治疗的转变。从蛋白质组学、转录组学和表观遗传学角度对鼻息肉慢性鼻窦炎各种表型形成的免疫机制进行的进一步研究，为开发基于新药的该疾病治疗方法带来了希望，这可以显著减少患有这种病症患者的手术治疗需求。
