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Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis.

使用内皮型、表型和炎症标志物指导慢性鼻-鼻窦炎的治疗决策。

  • 影响因子:2.00
  • DOI:10.1016/j.anai.2020.01.013
  • 作者列表:"Staudacher AG","Peters AT","Kato A","Stevens WW
  • 发表时间:2020-04-01
Abstract

OBJECTIVE:With the advent of new treatment options for Chronic Rhinosinusitis (CRS) comes the ability for physicians to provide more individualized patient care. Physicians are now tasked with identifying who may be the best candidate for a particular therapy. In this review, existing biomarkers and potentially new methods that could guide treatment choices in CRS patients will be discussed. DATA SOURCES:Published literature obtained through PubMed searches. STUDY SELECTION:Studies relevant to inflammatory endotypes, phenotypes, and biomarkers in CRS were included. RESULTS:Currently, there are no clinically validated tools that determine the best therapeutic modality for CRS patients with or without nasal polyps (CRSwNP or CRSsNP). Patients with CRS can be classified into three endotypes based on the presence of type 1, type 2, or type 3 inflammation. CRS endotypes can be influenced by age and geographic location. Clinical application however may be limited since endotyping current requires basic research laboratory support. Clinical symptoms may also predict inflammatory endotypes with smell loss being indicative of type 2 inflammation. Numbers of tissue and/or peripheral eosinophils as well as levels of IgE may predict disease severity in CRSwNP but not necessarily treatment responses. Unique clinical phenotypes or biomarkers are especially lacking that predict type 1 or type 3 inflammation in CRSwNP or type 1, type 2, or type 3 inflammation in CRSsNP. CONCLUSION:While significant progress has been made in characterizing endotypes, phenotypes, and biomarkers in CRS, additional studies are needed to determine if and how these factors could assist physicians in providing more individualized clinical care.

摘要

目的: 随着慢性鼻-鼻窦炎 (CRS) 新治疗方案的出现,医生能够提供更个体化的患者护理。医生现在的任务是确定谁可能是特定治疗的最佳候选人。在这篇综述中,将讨论现有的生物标志物和可能指导CRS患者治疗选择的新方法。 数据来源: 通过PubMed检索获得的已发表文献。 研究选择: 纳入与CRS中炎性内型、表型和生物标志物相关的研究。 结果: 目前,尚无临床验证的工具确定伴或不伴鼻息肉的CRS患者 (CRSwNP或CRSsNP) 的最佳治疗方式。根据 1 型、 2 型或 3 型炎症的存在,CRS患者可分为三种内型。CRS endotype可受年龄和地理位置的影响。然而,临床应用可能受到限制,因为内分型电流需要基础研究实验室支持。临床症状也可以预测炎性内型,嗅觉丧失提示 2 型炎症。组织和/或外周嗜酸性粒细胞的数量以及IgE水平可以预测CRSwNP的疾病严重程度,但不一定是治疗反应。尤其缺乏预测CRSwNP中 1 型或 3 型炎症或CRSsNP中 1 型、 2 型或 3 型炎症的独特临床表型或生物标志物。 结论: 虽然在表征CRS的内型、表型和生物标志物方面取得了重大进展,但还需要额外的研究来确定这些因素是否以及如何帮助医生提供更个体化的临床护理。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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