慢性鼻窦炎的炎症内型及其对合并哮喘的影响

文献信息

中文摘要

慢性鼻窦炎（CRS）与哮喘常共存，并日益被视为共同“统一气道”炎症过程的表现。然而，临床异质性仍然显著，仅凭传统表型无法可靠预测上下气道的疾病轨迹或治疗反应。基于内型的分类，特别是2型与非2型炎症的区分，提供了一个可优化预后判断并支持更个体化管理的框架。本综述综合了当前将CRS炎症内型与哮喘严重程度、急性发作风险以及术后或药物治疗结局联系起来的证据。我们总结了常规诊疗和研究环境中使用的实用生物标志物，并讨论了这些标志物如何为合并哮喘的CRS治疗决策提供信息。在2型疾病中，内型和生物标志物谱可支持更个体化的治疗方法，同时为持续症状或复发患者的升级治疗路径提供信息，包括在精心选择的病例中考虑生物制剂治疗。我们还强调了当前方法的局限性，包括炎症模式之间的重叠、组织与全身生物标志物之间的变异性，以及非2型CRS仍在演变中的定义，这些都可能限制常规临床决策中的精准医学。未来的优先事项包括内型定义的标准化、实用生物标志物组合的验证，以及协调上下气道结局的整合多学科路径。基于生物学的分层方法可能最终能够更好地为手术、皮质类固醇策略和生物制剂选择患者，改善CRS和哮喘的长期控制。

英文摘要

Chronic rhinosinusitis (CRS) and asthma frequently coexist and are increasingly understood as manifestations of a shared "united airway" inflammatory process. However, clinical heterogeneity remains substantial, and conventional phenotyping alone does not reliably predict disease trajectory or treatment response across the upper and lower airways. Endotype-based classification, particularly differentiation of type 2 and non-type 2 inflammation, offers a framework that can refine prognostication and support more individualized management. This review synthesizes current evidence linking CRS inflammatory endotypes with asthma severity, exacerbation risk, and postoperative or medical outcomes. We summarize practical biomarkers used in routine care and research settings and discuss how these markers inform therapeutic decisions in CRS with comorbid asthma. In type 2 disease, endotype and biomarker profiles can support a more individualized treatment approach, while also informing escalation pathways in patients with persistent symptoms or recurrence, including consideration of biologic therapy in carefully selected cases. We also highlight limitations of current approaches, including overlap between inflammatory patterns, variability between tissue and systemic biomarkers, and the still-evolving definition of non-type 2 CRS, all of which can limit precision medicine in routine clinical decision-making. Future priorities include standardization of endotype definitions, validation of pragmatic biomarker panels, and integrated multidisciplinary pathways that align upper- and lower-airway outcomes. A biology-informed stratification approach may ultimately enable better patient selection for surgery, corticosteroid strategies, and biologics, improving long-term control of both CRS and asthma.