迈向上气道炎症中鼻腔生物膜的细胞学分类：显微镜模式、临床意义与治疗启示。

文献信息

中文摘要

背景/目的： 鼻腔生物膜日益被认为参与慢性和复发性上气道炎症，但其细胞学解读仍常被简化为有/无的二元判断，低估了其在形态学、微生物学和炎症方面的异质性。本视角文章提出一个基于显微镜形态、组织化程度、细菌与真菌组成、宿主炎症反应及治疗启示的鼻腔生物膜细胞学分类框架。方法：该概念框架整合了标准化鼻腔细胞学、细菌聚集体及类生物膜结构的显微镜观察、May-Grünwald-Giemsa染色特征，以及当前关于上气道炎症性疾病中生物膜行为的知识，重点关注细菌、真菌成分、黏液、上皮细胞与炎症浸润之间的关系。结果：提出五种细胞学模式：游离细菌定植、微聚集体类生物膜模式、结构化/成熟生物膜模式、炎症性生物膜相关模式，以及播散/破坏性生物膜模式，反映不同程度的微生物组织化及宿主-微生物相互作用，并可能在同一涂片中并存。鼻腔细胞学还可能显示以真菌为主或细菌-真菌混合的模式，支持“感染性共居”概念，并应区分孤立的真菌孢子与更罕见、临床意义更大的营养形式如菌丝。结论：从有/无判断转向基于模式的解读，可能提高鼻腔细胞学的诊断和临床价值。尽管需要前瞻性验证，该分类提供了一种共享的描述性语言，可能有助于更精确地对上气道炎症进行表型分型，避免对单纯定植的过度解读，并为个体化诊断和治疗策略提供信息。

英文摘要

Background/Objectives: Nasal biofilms are increasingly recognized as contributors to chronic and recurrent upper airway inflammation, yet their cytological interpretation is still often reduced to a binary presence/absence judgment, underestimating their morphological, microbial, and inflammatory heterogeneity. This Perspective proposes a cytological classification framework for nasal biofilms based on microscopic morphology, degree of organization, bacterial and fungal composition, host inflammatory response, and therapeutic implications. Methods: This conceptual framework integrates standardized nasal cytology, microscopic observation of bacterial aggregates and biofilm-like structures, May-Grünwald-Giemsa staining features, and current knowledge of biofilm behavior in upper airway inflammatory disorders, focusing on relationships among bacteria, fungal elements, mucus, epithelial cells, and inflammatory infiltrates. Results: Five cytological patterns are proposed: free bacterial colonization, microaggregate biofilm-like pattern, structured/mature biofilm pattern, inflammatory biofilm-associated pattern, and dispersal/disrupted biofilm pattern, reflecting different degrees of microbial organization and host-microbe interaction and possibly coexisting within the same smear. Nasal cytology may also reveal fungal-predominant or mixed bacterial-fungal patterns, supporting an "infectious condominium" concept, and should distinguish isolated fungal spores from the rarer, clinically more significant vegetative forms such as hyphae. Conclusions: Moving from a presence/absence approach to pattern-based interpretation may improve the diagnostic and clinical value of nasal cytology. Although prospective validation is required, this classification offers a shared descriptive language that may support more precise phenotyping of upper airway inflammation, avoid overinterpretation of simple colonization, and inform personalized diagnostic and therapeutic strategies.