缓解：在伴有鼻息肉的慢性鼻-鼻窦炎中是否已经存在？
Remission: does it already exist in chronic rhinosinusitis with nasal polyposis?
机构信息
Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Unit 8-163 CC North, Toronto, ON, M5B 1W8, Canada.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
出版信息
J Otolaryngol Head Neck Surg. 2023 Jul 28;52(1):50. doi: 10.1186/s40463-023-00657-2.
BACKGROUND
Remission, defined as absence of symptoms and objective markers of disease, is emerging as the penultimate goal in the management of several chronic diseases. The concept of remission, well-established in Rheumatology as well as Gastroenterology, is currently emerging in Respiratory Medicine for asthma. It is interesting to consider whether the disease remission concept might successfully be applied to Otolaryngology-Head and Neck Surgery in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP).
OBJECTIVE
The purpose of this letter is to explore the evidence supporting the concept of remission under continued medical therapy in chronic rhinosinusitis with nasal polyposis.
METHODS
The authors reviewed the literature and summarized studies in chronic rhinosinusitis with nasal polyposis evaluating for evidence of clinical, biochemical, and endoscopic remission.
RESULTS
Findings of the studies revealed that endoscopic sinus surgery with continued medical therapy achieved remission in approximately 50% of all patients. CRSwNP patients after primary endoscopic sinus surgery were able to achieve remission in 72% of instances, however this drops to 42% for patients having revision sinus surgery. For CRSwNP patients with co-morbidities such as asthma and aspirin exacerbated respiratory disease, remission rate drops to 23% and 23.5%, respectively compared to non-asthmatic CRSwNP patients who present a remission rate under continued medical therapy of 60%.
CONCLUSION
Remission of symptoms and evidence of disease under medical therapy is indeed a concept achievable in patients with CRSwNP, as demonstrated by studies in the literature. Various co-morbidities, notably asthma, apparently influence rate of remission. Better defining this outcome through consensus-based definitions will allow for the development of strategies in CRSwNP care that can help affected patients attain complete relief from clinical, biochemical, and endoscopic markers of CRS with judicious use of medication and surgery. Future efforts will attempt to improve on these outcomes by achieving symptomatic and endoscopic control of disease following cessation of therapy, potentially paving the way towards clinical remission or a 'cure' in CRS.
背景
缓解，定义为无疾病症状和客观标志物，在多种慢性疾病的管理中逐渐成为仅次于痊愈的目标。在风湿病学和胃肠病学中已确立的缓解概念，目前在哮喘的呼吸医学中也逐渐出现。考虑缓解概念是否可以成功应用于耳鼻喉科-头颈外科慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的管理中是很有趣的。
目的
本文旨在探讨持续药物治疗下慢性鼻-鼻窦炎伴鼻息肉缓解的证据。
方法
作者查阅文献并总结了评估慢性鼻-鼻窦炎伴鼻息肉临床、生化和内镜缓解证据的研究。
结果
研究结果显示，持续药物治疗联合鼻内镜手术可使约 50%的患者缓解。初次鼻内镜手术后的 CRSwNP 患者有 72%的患者能够缓解，但再次鼻内镜手术的患者缓解率降至 42%。对于伴有哮喘和阿司匹林加重性呼吸道疾病等合并症的 CRSwNP 患者，缓解率分别降至 23%和 23.5%，而非哮喘 CRSwNP 患者在持续药物治疗下的缓解率为 60%。
结论
正如文献中的研究所示，在 CRSwNP 患者中，通过药物治疗缓解症状和疾病证据是可以实现的。各种合并症，特别是哮喘，显然会影响缓解率。通过基于共识的定义更好地定义这一结果，将有助于制定 CRSwNP 护理策略，使受影响的患者能够通过合理使用药物和手术，从临床、生化和内镜上的 CRS 标志物中获得完全缓解。未来的研究将努力通过停止治疗后实现疾病的症状和内镜控制来改善这些结果，从而为 CRS 中的临床缓解或“治愈”铺平道路。
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