2型CRSwNP的生物治疗：从免疫病理学到临床管理

文献信息

中文摘要

背景： 慢性鼻窦炎伴鼻息肉（CRSwNP）是一种异质性炎症性疾病，其中2型（T2）炎症是主要的内型，其特征为嗜酸性粒细胞浸润以及IL-4、IL-5和IL-13通路的激活。T2-CRSwNP患者常合并哮喘、非甾体抗炎药加重性呼吸系统疾病，并且复发风险高。基于鼻内或全身糖皮质激素及内镜鼻窦手术的传统管理可缓解症状，但在持续存在T2炎症的患者中往往无法实现持续的疾病控制。
目的： 本综述总结T2-CRSwNP的免疫病理学和风险分层，并在结构化临床决策框架内讨论生物治疗的当前证据和实践考虑。
结论： 靶向IL-4Rα、IL-5/IL-5R、IgE和TSLP的生物治疗已显示出减少息肉负荷、改善症状和降低全身糖皮质激素暴露的疗效。然而，在缺乏稳健的头对头比较的情况下，最佳患者选择和确定可持续的长期维持策略仍是临床挑战。整合炎症特征、疾病负担和结构化随访可能有助于个体化治疗和持续疾病控制。

英文摘要

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder in which type 2 (T2) inflammation represents the predominant endotype, characterized by eosinophilic infiltration and activation of IL-4, IL-5, and IL-13 pathways. Patients with T2-CRSwNP frequently present with asthma, NSAID-exacerbated respiratory disease, and a high risk of recurrence. Conventional management based on intranasal or systemic corticosteroids and endoscopic sinus surgery may relieve symptoms but often fails to achieve sustained disease control in patients with persistent T2 inflammation.
PURPOSE: This review summarizes the immunopathology and risk stratification of T2-CRSwNP and discusses current evidence and practical considerations for biologic therapy within a structured clinical decision framework.
CONCLUSIONS: Biologic therapies targeting IL-4Rα, IL-5/IL-5R, IgE, and TSLP have demonstrated efficacy in reducing polyp burden, improving symptoms, and decreasing systemic corticosteroid exposure. However, in the absence of robust head-to-head comparisons, optimal patient selection and defining sustainable long-term maintenance strategies remain clinical challenges. Integrating inflammatory profiles, disease burden, and structured follow-up may support individualized treatment and sustained disease control.