PDF(Pubmed)
Abstract：
Chronic rhinosinusitis (CRS) with (CRSwNP) or without (CRSsNP) nasal polyps is a prevalent and heterogeneous disorder existing as a spectrum of clinical conditions with complex underlying pathomechanisms. CRS comprises a broad syndrome characterized by multiple immunological features involving complex interactions between the genes, the microbiome, host- and microbiota-derived exosomes, the epithelial barrier, and environmental and micromilieu exposures. The main pathophysiological feature is an epithelial barrier disruption, accompanied by microbiome alterations and unpredictable and multifactorial immunologic overreactions. Extrinsic pathogens and irritants interact with multiple epithelial receptors, which show distinct expression patterns, activate numerous signaling pathways, and lead to diverse antipathogen responses. CRSsNP is mainly characterized by fibrosis and mild inflammation and is often associated with Th1 or Th17 immunological profiles. CRSwNP appears to be associated with moderate or severe type 2 (T2) or Th2 eosinophilic inflammation. The diagnosis is based on clinical, endoscopic, and imaging findings. Possible CRS biomarkers from the peripheral blood, nasal secretions, tissue biopsies, and nasally exhaled air are studied to subgroup different CRS endotypes. The primary goal of CRS management is to maintain clinical control by nasal douching with isotonic or hypertonic saline solutions, administration of nasal and systemic steroids, antibiotics, biologic agents, or, in persistent and more severe cases, appropriate surgical procedures.
摘要：
伴有（CRSwNP）或不伴有（CRSsNP）鼻息肉的慢性鼻-鼻窦炎（CRS）是一种普遍存在的异质性疾病，存在于一系列具有复杂潜在病理机制的临床疾病中。CRS包括一种广泛的综合征，其特征是多种免疫学特征，涉及基因之间的复杂相互作用。微生物组,宿主和微生物群来源的外泌体，上皮屏障，以及环境和微环境暴露。主要病理生理特征是上皮屏障破坏，伴随着微生物组改变和不可预测的多因素免疫反应。外源性病原体和刺激物与多种上皮受体相互作用，表现出不同的表达模式，激活许多信号通路，并导致不同的抗病原体反应。CRSsNP主要以纤维化和轻度炎症为特征,并且通常与Th1或Th17免疫谱相关。CRSwNP似乎与中度或重度2型（T2）或Th2嗜酸性粒细胞炎症有关。诊断是基于临床，内窥镜,和成像发现。来自外周血的可能的CRS生物标志物，鼻腔分泌物,组织活检,研究了鼻呼出气对不同CRS基因型的亚组。CRS管理的主要目标是通过等渗或高渗盐溶液鼻腔冲洗来维持临床控制。鼻和全身类固醇的给药，抗生素,生物制剂，或者，在持续和更严重的情况下，适当的外科手术。
