慢性鼻窦炎在内镜鼻窦手术或生物制剂升级治疗前的药物治疗：一项批判性范围综述

文献信息

中文摘要

背景： 慢性鼻窦炎（CRS）是一种异质性炎症性疾病，其药物治疗应根据内型、疾病严重程度和患者特异性因素进行个体化调整。本综述审视了在升级至内镜鼻窦手术或生物制剂之前支持药物治疗的证据。
方法： 鼻内糖皮质激素和盐水冲洗仍是治疗的基础。短期全身性糖皮质激素可能对伴鼻息肉的CRS提供暂时获益，但由于严重的累积不良反应，应限制重复暴露。长期全身性抗生素治疗CRS的证据不一致，特别是长期大环内酯类药物不应被视为治疗升级前的普遍先决条件，尤其是在2型炎症性疾病中。局部抗生素可能在部分术后患者中有用，而抗组胺药和过敏原免疫治疗应保留给具有临床相关过敏性疾病而非仅有致敏的患者。
结果： 因此，适当的药物治疗应反映对个体患者内型和特征具有已证实获益的治疗，而不是要求所有可用选项序贯失败。
结论： 对于持续未控制的疾病患者，升级至手术或生物制剂应依据疾病特征、合并症、既往治疗、治疗负担和患者偏好来指导。

英文摘要

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease in which medical treatment should be tailored to endotype, disease severity, and patient-specific factors. This review examines the evidence supporting medical therapy before escalation to endoscopic sinus surgery or biologics. Intranasal corticosteroids and saline irrigations remain the foundation of treatment. Short courses of systemic corticosteroids may provide temporary benefit in CRS with nasal polyps, but repeated exposure should be limited because of severe cumulative adverse effects. Evidence for prolonged systemic antibiotic therapy in CRS is inconsistent, and specifically long-term macrolides should not be considered a universal prerequisite before treatment escalation, particularly in type 2 inflammatory disease. Topical antibiotics may be useful in selected postoperative patients, while antihistamines and allergen immunotherapy should be reserved for patients with clinically relevant allergic disease rather than sensitization alone. Appropriate medical therapy should therefore reflect treatments with demonstrated benefit for the individual patient's endotype and characteristics, rather than require sequential failure of all available options. In patients with persistent uncontrolled disease, escalation to surgery or biologics should be guided by disease characteristics, comorbidities, prior treatment, treatment burden, and patient preference.