慢性鼻窦炎伴鼻息肉治疗的新进展：从病理生理学到生物靶向治疗。

文献信息

中文摘要

背景： 慢性鼻窦炎伴鼻息肉（CRSwNP）是一种主要以2型炎症为特征的慢性气道疾病，严重损害患者的生活质量并造成巨大的经济负担。传统治疗无法根除潜在的免疫紊乱，导致术后高复发率。本综述旨在总结CRSwNP的病理生理基础以及生物制剂在其精准治疗中的临床应用进展。
方法： 通过叙述性综述综合关于CRSwNP病理生理学的关键文献，重点关注2型炎症分子（IL-4、IL-13、IL-5、IgE、TSLP）的核心作用以及靶向生物制剂治疗难治性CRSwNP的临床证据。
结果： 对CRSwNP病理生理学的深入理解推动了向精准医学的转变。包括dupilumab（抗IL-4Rα）、mepolizumab（抗IL-5）、omalizumab（抗IgE）和tezepelumab（抗TSLP）在内的生物制剂能够精准靶向2型炎症通路中的关键分子，实现有效且持久的疾病控制，减少息肉体积，改善鼻部症状和嗅觉功能，减少对口服糖皮质激素的依赖和再次手术的需求，并对合并哮喘发挥协同作用。
结论： 生物制剂标志着CRSwNP治疗的里程碑，将临床管理从对症治疗转变为基于患者内型、合并症和治疗目标（如疾病缓解）的个体化决策。未来的研究将集中于预测性生物标志物、头对头比较研究以及非2型炎症的新靶点，以优化长期管理。通过将近期生物制剂证据与基于内型的复发机制相结合，本综述为CRSwNP的生物制剂管理和以缓解为导向的管理提供了实用框架。

英文摘要

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic airway disease characterized mainly by type 2 inflammation, which seriously impairs patients' quality of life and imposes a huge economic burden. Traditional treatments cannot eradicate underlying immune disorders, leading to high postoperative recurrence. This review aims to summarize the pathophysiological basis of CRSwNP and the clinical application advances of biologics in its precision treatment.
METHODS: A narrative review was performed to synthesize key literature on the pathophysiology of CRSwNP, focusing on the core role of type 2 inflammatory molecules (IL-4, IL-13, IL-5, IgE, TSLP) and the clinical evidence of targeted biologics for refractory CRSwNP.
RESULTS: In-depth understanding of CRSwNP pathophysiology has promoted the shift to precision medicine. Biologics including dupilumab (anti-IL-4Rα), mepolizumab (anti-IL-5), omalizumab (anti-IgE) and tezepelumab (anti-TSLP) can precisely target key molecules in type 2 inflammatory pathways, achieving effective and long-lasting disease control, reducing polyp volume, improving nasal symptoms and olfactory function, decreasing reliance on oral corticosteroids and the need for reoperation, and exerting synergistic effects on comorbid asthma.
CONCLUSIONS: Biologics mark a milestone in CRSwNP treatment, shifting clinical management from symptomatic treatment to individualized decision-making based on patient endotypes, comorbidities and treatment goals such as disease remission. Future research will focus on predictive biomarkers, head-to-head comparative studies and new targets for non-type 2 inflammation to optimize long-term management. By integrating recent biologic evidence with endotype-based recurrence mechanisms, this review provides a practical framework for biologic stewardship and remission-oriented management in CRSwNP.