病例报告：嗅觉丧失作为不伴鼻息肉的2型慢性鼻窦炎的哨兵表现：对IL-4Rα抑制药物stapokibart的应答——一项病例系列。

文献信息

中文摘要

背景： 不伴鼻息肉的慢性鼻窦炎（CRSsNP）传统上与1型炎症相关，但新出现的证据揭示了一个由IL-4和IL-13驱动的2型内型患者亚群，常表现为显著的嗅觉功能障碍，且对常规治疗反应不佳。方法：我们报告了三例伴有过敏性鼻炎的2型CRSsNP病例（年龄29-30岁，两男一女），他们以令人衰弱的嗅觉丧失作为哨兵症状就诊。所有患者均有2型生物标志物升高、无鼻息肉，并有鼻窦炎的CT证据。在鼻内糖皮质激素治疗失败后，他们接受了stapokibart治疗（600 mg负荷剂量，随后300 mg每两周一次，共16周）。结果：嗅觉改善在两周内出现，并持续至第16周；SNOT-22评分下降约90%，Lund-Mackay评分降至0（病例1和2）和1（病例3）。所有患者血清总IgE下降；嗜酸性粒细胞计数在两名患者中下降，但在一名患者中反常升高。未发生严重不良事件。结论：伴有显著嗅觉功能障碍的2型CRSsNP是一种独特的、可治疗的表型。Stapokibart可快速改善对常规治疗难治患者的嗅觉功能，支持针对CRS的内型驱动生物制剂策略。

英文摘要

Chronic rhinosinusitis without nasal polyps (CRSsNP) is traditionally associated with type 1 inflammation, but emerging evidence reveals a subset of patients with a type 2 endotype driven by IL-4 and IL-13, often presenting with prominent olfactory dysfunction and responding poorly to conventional therapy. We report three cases of type 2 CRSsNP with comorbid allergic rhinitis (aged 29-30 years, two males, one female) who presented with debilitating olfactory loss as the sentinel symptom. All had elevated type 2 biomarkers, absence of nasal polyps, and CT evidence of sinusitis. After failure of intranasal corticosteroids, they received stapokibart (600 mg loading dose, then 300 mg every two weeks for 16 weeks). Olfactory improvement occurred within two weeks and was sustained through week 16; SNOT-22 scores decreased by approximately 90%, and Lund-Mackay scores decreased to 0 (Cases 1 and 2) and 1 (Case 3). Serum total IgE decreased in all patients; eosinophil counts decreased in two but paradoxically increased in one. No serious adverse events occurred. Type 2 CRSsNP with prominent olfactory dysfunction is a distinct, treatable phenotype. Stapokibart rapidly improves olfactory function in patients refractory to conventional therapy, supporting an endotype-driven biologic strategy for CRS.