Karpischenko Sergey, Jung Yong Gi, Kim Dae-Woo, Spriggs Kymble, Tsang Raymond King-Yin, Yeh Te-Huei
ENT Department, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
ENT Department, K.A. Rauhfus Children's City Multidisciplinary Clinical Center for High Medical Technologies, Saint Petersburg, Russia.
Asia Pac Allergy. 2024 Jun;14(2):77-83. doi: 10.5415/apallergy.0000000000000139. Epub 2024 Apr 4.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. An expert panel of specialists from the Asian-Pacific region and Russia was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations from this panel to provide guidance for clinicians in these areas. Etiology and pathogenetic mechanisms in CRSwNP are heterogeneous and complex. In many patients, CRSwNP is primarily driven by type 2 inflammation, although this may be less important in Asian populations. Frequent comorbidities include asthma and other inflammatory diseases such as non-steroidal anti-inflammatory drug (NSAID)/aspirin-exacerbated respiratory disease or atopic dermatitis. Clinical management of CRSwNP is challenging, and a multidisciplinary approach to evaluation and treatment is recommended. While many patients respond to medical treatment (topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), those with more severe/uncontrolled disease usually require endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, requiring revision surgery. Biological therapies targeting underlying type 2 inflammation offer additional, effective treatment options in uncontrolled disease, either as an alternative to ESS or for those patients with persistent symptoms despite ESS.
伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是鼻腔和鼻窦组织的一种慢性炎症性疾病，其特征为双侧鼻息肉的存在。来自亚太地区和俄罗斯的专家小组召开会议，通过共识方法制定CRSwNP管理的区域指南。本文介绍了该小组的主要观察结果和建议，为这些领域的临床医生提供指导。CRSwNP的病因和发病机制是异质性和复杂的。在许多患者中，CRSwNP主要由2型炎症驱动，尽管在亚洲人群中这可能不那么重要。常见的合并症包括哮喘和其他炎症性疾病，如非甾体抗炎药（NSAID）/阿司匹林诱发的呼吸道疾病或特应性皮炎。CRSwNP的临床管理具有挑战性，建议采用多学科方法进行评估和治疗。虽然许多患者对药物治疗（局部冲洗和鼻内使用皮质类固醇，以及短期辅助使用全身皮质类固醇）有反应，但那些病情更严重/未得到控制的患者通常需要内镜鼻窦手术（ESS），尽管手术结果可能不尽人意，需要进行翻修手术。针对潜在2型炎症的生物疗法为未得到控制的疾病提供了额外的有效治疗选择，既可以替代ESS，也适用于那些尽管接受了ESS但仍有持续症状的患者。
