86例成人Ph染色体阴性急性B淋巴细胞白血病自体造血干细胞移植疗效及微小残留病检测的临床意义

目的 探讨自体造血干细胞移植(auto-HSCT)在成人Ph染色体阴性急性B淋巴细胞白血病(B-ALL)中的地位及其预后因素.方法 回顾性分析1996年1月至2014年2月86例首次行auto-HSCT患者的疗效.结果 5年总生存(OS)和无病生存(DFS)率分别为(63.8±5.6)％和(60 9±5.6)％,5年累积无复发死亡(NRM)率和复发率分别为(4.70±0.05)％和(34.40±0.31)％.年龄≥35岁、诊断时乳酸脱氢酶水平高、高白细胞起病、首次诱导治疗第15天骨髓原始细胞比例≥5％、第1次完全缓解(CR1)至移植时间间隔＞6个月及回输物中CD34+细胞数≥3.8× 106/kg均为不良预后因素.且CR1至移植时间间隔＞6个月是影响预后的独立不良因素.34例患者具有微小残留病(MRD)检测结果,显示移植前MRD阳性(MRD≥0.01％)、首次诱导化疗后MRD未转阴或巩固化疗过程中MRD转阳均提示不良预后,且巩固化疗中MRD转阳是影响DFS的独立不良因素.结论 auto-HSCT联合维持化疗是成人B-ALL治疗的可选方案.由于移植前及化疗过程中MRD阴性结果提示更好的结局,故MRD可能在指导成人B-ALL移植治疗中具有重要意义.     

10岁以上儿童、青少年急性淋巴细胞白血病的临床研究

目的 研究大年龄急性淋巴细胞白血病(ALL)患儿的临床与预后特征.方法 2005年5月1日至2009年4月30日采用ALL-2005方案治疗10岁以上的ALL患儿共67例,根据细胞形态学、免疫学、细胞遗传学和分子生物学特点进行临床分组,并按分组治疗.对患儿进行临床特点、疗效及生存分析.结果 在67例大年龄ALL患儿中男40例(59.7％),女27例(40.3％),平均年龄12.3岁,中位年龄12.2(10.0～17.8)岁,进入中危和高危组的患儿分别为48例和19例.在诱导缓解治疗中,泼尼松窗口试验反应好和治疗第19天骨髓达M1的比例分别为83.6％和86.6％.有59例(88.1％)患儿在诱导第30～ 35天达骨髓形态学缓解,达缓解时间为(31.8±2.9)d,有微量残留病(MRD)标志的58例患儿中,42例(72.4％)在1个疗程后MRD ＜0.01％,在治疗过程中有7例患儿出现MRD阳性,2例患儿接受骨髓移植治疗.共15例患儿复发,持续完全缓解至复发时间为(14.9±9.9)个月.大年龄ALL患儿的5年无事件生存(EFS)和总生存(OS)率分别为(64.4±6.3)％和(74.1±6.1)％.单因素分析发现初诊时的高血清铁蛋白水平、伴有bcr-abl融合基因、窗口治疗反应差、第19天骨髓形态学非M1状态、第1个疗程结束时的骨髓形态学不缓解和MRD阳性与患儿预后不良呈显著相关性.多因素分析发现第1个疗程结束时骨髓MRD阳性与患儿预后不良呈显著相关性(RR =2.20,95％CI1.26 ～3.84,P＜0.01).结论 ALL-2005方案对大年龄ALL患儿疗效良好,初诊时的血清铁蛋白水平、融合基因检测、早期治疗反应以及治疗过程中的MRD监测可以作为判断患儿预后的指标.     

IKZF1基因突变是成人B系急性淋巴细胞白血病患者预后不良的因素

目的:分析合并IKZF1基因突变的成人B系急性淋巴细胞白血病(B-ALL)患者的预后,探讨异基因造血干细胞移植(allo-HSCT)可否改善患者预后。方法:收集经毛细管电泳法检测骨髓IKZF1基因突变164例成人B-ALL患者的临床资料,分析IKZF1基因突变与成人B-ALL患者的预后关系。结果:164例成人B-ALL患者中IKZF1基因突变阳性80例,阴性84例。80例IKZF1基因突变阳性患者根据诱导化疗缓解后的治疗方式分为移植组(48例)和化疗组(32例)。分析结果显示,移植组中IKZF1突变阳性患者的3年总生存(OS)率、无白血病生存(LFS)率分别为50.3%±8.3%和41.6%±8.5%,化疗组分别为33.7%±12.8%和31.5%±9.5%,均明显低于IKZF1突变阴性患者率(79.5%±7.6%、64.0%±8.4%)和(54.4%±9.9%、40.6%±9.6%)(P<0.05)。IKZF1突变阳性80例患者中移植组3年OS和LFS率(55.3%±7.5%和48.3%±7.6%)明显高于化疗组(32.9%±11.8%和28.4%±10.3%)(P<0.05)。结论:IKZF1基因突变是成人B-ALL预后不良的因素,allo-HSCT可明显提高IKZF1突变阳性成人B-ALL患者的3年OS和LFS率,从而改善其预后。     

伊马替尼联合改良的Hyper-CVAD/MA强化方案及异基因造血干细胞移植一线治疗成人Ph阳性急性淋巴细胞白血病的临床研究

目的 探讨采用伊马替尼(IM)联合化疗后第1次完全缓解期(CR1)行异基因造血干细胞移植(allo-SCT)及IM维持治疗成人Ph阳性急性淋巴细胞白血病(Ph+-ALL)的临床疗效及相关预后因素.方法 2006年3月至2010年12月在我院淋巴肿瘤中心CR1期完成allo-SCT治疗的16例成人Ph+-ALL患者纳入研究.所有患者均以IM联合标准VDCP±L(长春新碱+柔红霉素+环磷酰胺+泼尼松±左旋门冬酰胺酶)方案诱导治疗,缓解后则联合改良HyperCVAD/MA方案强化巩固治疗,并于CR1期行allo-SCT;部分患者移植后给予IM维持治疗.随访至2011年3月31日,分析患者临床基本特征、总生存(OS)率、无病生存(DFS)率、累积复发(RI)率及非复发死亡(NRM)率,并探讨与生存相关的预后因素.结果 16例患者采用IM联合化疗在移植前均维持血液学缓解,其中10例达分子生物学缓解.移植后所有患者均成功植入.中位随访27.1(7.4 ～65.8)个月,14例患者存活,其中2例患者移植后复发经IM挽救均存活,2例非复发死亡.3年预期OS及DFS率分别为(85.9±9.3)％和(83.9±10.5)％,3年RI率及NRM率分别为(16.1±10.5)％和(14.1±9.3)％.生存分析未显示影响移植疗效的预后因素.结论 IM联合化疗及Hyper-CVAD/MA强化治疗可显著提高Ph+-ALL患者的缓解率及缓解质量,使患者在CR1期行allo-SCT的可行性增高.allo-SCT前、后联合IM能减少复发,提高长期OS及DFS率,是治疗成人Ph+-ALL的有效手段.     

酪氨酸激酶抑制剂联合化疗后行异基因造血干细胞移植治疗Ph+急性淋巴细胞白血病与异基因造血干细胞移植治疗Ph-急性淋巴细胞白血病的疗效比较

目的 比较Ph染色体阳性(Ph+)急性淋巴细胞白血病(ALL)患者应用化疗联合酪氨酸激酶抑制剂(TKI)后行异基因造血干细胞移植(allo-HSCT)和Ph染色体阴性(Ph-)ALL患者化疗后进行allo-HSCT的疗效和安全性.方法 2003年1月至2014年8月行allo-HSCT的55例B-ALL患者中配对选取19例Ph-ALL患者(Ph-ALL组)与19例TKI联合allo-HSCT的Ph+ALL患者进行回顾性分析.结果 Ph+ALL组和Ph-ALL组在性别、中位年龄、发病时外周血WBC＞ 30× 109/L的例数、合并中枢神经系统白血病的例数、移植前疾病缓解状态、移植时间、干细胞来源、供受者HLA相合情况、预处理方案、输入单个核细胞数和CD34+细胞数等方面基本匹配.Ph+ALL组和Ph-ALL组白细胞和血小板植活时间相当(12d和13d,P=0.284;14 d和17d,P=0.246).Ph+ALL组和Ph-ALL组3年总生存率和无病生存率分别为(67.5±12.4)％和(74.3±11.4)％(P=0.434)、(67.8±12.4)％和(74.3±11.4)％(P=0.456),差异均无统计学意义.Ph+ALL组和Ph-ALL组Ⅱ～Ⅳ度急性移植物抗宿主病(aGVHD)的累积发生率分别为(15.8±8.4)％和(21.1±9.4)％(P=0.665),其中Ⅲ～Ⅳ度aGVHD的累积发生率分别为(5.6±5.4)％和(11.5±7.6)％(P=0.541).慢性移植物抗宿主病(cGVHD)的累积发生率分别为(44.1±14.0)％和(44.1±13.0)％(P=0.835),其中广泛型cGVHD的累积发生率分别为(13.1±8.7)％和(6.2±6.1)％(P=0.379).Ph+ALL组和Ph ALL组累积复发率和累积非复发死亡率差异亦无统计学意义[分别为(10.8±7.2)％对(20.0±10.7)％(P=0.957)和(23.9±12.4)％对(7.1±6.9)％(P=0.224)].结论 Ph+ALL患者化疗联合TKI后行allo-HSCT与Ph-ALL患者行allo-HSCT的疗效相当.     

造血干细胞移植治疗成人急性淋巴细胞白血病

成人急性淋巴细胞白血病(ALL)联合化疗完全缓解(CR)率可达70～90%,但复发率(RR)较高,长期无病生存(DFS)率只有30%左右,远低于儿童ALL的疗效。造血干细胞移植(HSCT)是治疗成人ALL最有效的方法之一,近年来取得了较大的进展。本文拟就HLA匹配同胞供者异基因造血干细胞移植(allo-HSCT)治疗成人ALL的适应证、影响疗效相关因素、其他类型移植、Ph ALL移植等方面的进展进行介绍。1成人ALL预后因素根据不同预后因素对成人ALL患者进行个体化治疗,对于提高疗效十分重要。有关成人ALL目前比较公认的预后不良因素如下[1,2]:诊断时年龄…     

203例慢性淋巴细胞白血病患者预后相关因素分析

目的 探讨慢性淋巴细胞白血病(CLL)患者预后的主要影响因素.方法 回顾性分析2000年至2007年就诊于中国医学科学院血液病医院并获得有效随访的203例CLL患者临床资料,收集可能影响预后的因素,以Kaplan-Meier法绘制生存曲线,用Log-rank检验进行单因素分析,运用COX回归模型评估独立预后因素.结果 全组CLL患者中位随访时间为48.0(3.0～156.0)个月,5年总体生存(OS)率为(87.3±2.4)%,10年OS率为(77.4 ±3.3)%,死亡48例(23.6%).单因素分析显示临床分期为晚期、有B症状、结外器官受累、受累淋巴区≥3个、肝脏肿大、Hb<100 g/L、BPC<100 ×109/L、外周血淋巴细胞计数(ALC)>50 ×109/L、形态学表现为混合细胞型、病程中出现分期进展、对治疗无反应、并发感染、并发第二肿瘤或类型转化为不良预后因素.多因素分析显示受累淋巴区≥3个和彤态学表现为混合细胞型为独立的不良预后因素,根据这两项结果重新分组,低危、中危、高危组患者5年OS率分别为(89.8±3.5)%、(66.4±7.2)%、(15.0±13.8)%.各组间差异均具有统计学意义(P值均<0.05).结论 初诊时受累淋巴区数和CLL细胞形态学特征有助于评估CLL患者的预后.     

EBMT积分在异基因造血干细胞移植治疗慢性粒细胞白血病中的预后价值

目的 分析慢性粒细胞白血病(CML)异基因造血干细胞移植(allo-HSCT)治疗的危险因素,以利于更好地规避移植风险.方法 回顾性研究分析121例接受allo-HSCT的CML患者.预后评估参照EBMT积分,即Gratwohl积分,危险因素包括供者来源、患者年龄、患者移植前疾病状态、供患者性别差异、疾病确诊至移植时间.将患者分为3组:低危组(0～2分)、中危组(3～4分)和高危组(5分).结果 所有患者allo-HSCT后中位随访时间为37(1～126)个月,预期5年总生存(OS)率、无复发死亡(NRM)率及复发(RR)率分别为(56.8 ±5.0)%、(35.6±4.9)%和(12.9±3.7)%.其中低危组患者分别为(66.0±6.1)%、(28.8±6.0)%和(7.8±3.3)%,明显优于中危组[(47.2±8.7)%、(43.6±8.5)%和(18.7±8.1)%]和高危组[(16.8±15.2)%、(66.7±25.5)%和(50.0±25.0)%],差异具有统计学意义(P值分别为0.0015、0.045和0.0053).结论 EBMT危险因素积分系统能全面反映预测allo-HSCT治疗CML的疗效、复发率和移植相关死亡率.

Abstract：

Objective To analyze the risk factors of allogeneic stem cell transplantation (allo-SCT)for chroninc myeloid leukemia (CML) in an attempt to avoid transplant risks. Methods A total of 121 CML patients received allo-SCT were analyzed retrospectively. The risk analysis was based on the EBMT score (gratwohl score) which included donor type, age of patients, disease status before transplantation, donor/recipient sex match and time interval between diagnosis to allo-SCT. Patients were divided into 3 risk groups based on their EBMT score: low risk (score 0-2), inzermediate risk(3- 4 ) and high-risk (5). Results The median follow-up duration was 37(1-126) months. The estimated 5-year overall urvival (5 y-OS),non-relapse mortality (5 y-NRM) and relapse rate (5 y-RR) were (56.8 ±5.0)％, (35.6 ±4.9)％ and ( 12.9 ± 3.7) ％, respectively. The 5y-OS, NRM and RR were ( 66.0 ± 6.1 ) ％, ( 28.8 ± 6.0 ) ％ and ( 7.8 ± 3.3 ) ％ in the low risk group being significantly superior to both intermediate-risk [ (47.2 ± 8.7 ) ％,(43.6±8.5)％and(18.7 ±8.1)％] and high-risk group [(16.8±15.2)％, (66.7 ±25.5)％ and (50.0 ± 25.0) ％ ] (P = 0.0015, 0.045 and 0.0053 for OS, NRM and RR respectively ). Conclusion The EBMT risk score can effectively predict the overall outcome, relapse and transplant-related mortality of allo-SCT for CML patients.     

8O例青少年急性淋巴细胞白血病MICM分型与临床预后分析

目的探讨青少年急性淋巴细胞白血病(ALL)的MICM分型特征及影响疗效和生存的因素.方法对1998年1月～2002年12月收治的80例13～18岁初治青少年ALL的MICM分型、临床特征及治疗转归进行回顾性研究,应用Kaplan-Meier法进行生存曲线预算、COX回归模型进行多因素预后分析.结果80例青少年ALL中,B-ALL与T-ALL各占69.12%和26.47%;Ph染色体阳性ALL(Ph+ALL)占18.37%(49例中有9例);超二倍体核型为4.08%;初诊时外周血白细胞计数＞50×109/L者占27.94%.经VDP(L)或CODP(L)治疗4周完全缓解(CR)率达91.03%.中位随访24个月,接受化疗(41例)和进行异基因造血干细胞移植(14例)患者的3年预期无病生存(DFS)率分别为(32.55±16.50)%和(69.58±8.72)%,差异有显著性(P＜0.05).COX多因素预后分析显示,外周血白细胞计数＞50×109/L和Ph染色体阳性是影响本组患者长期生存的危险因素.结论MICM分型对青少年ALL的预后评估和个体化治疗具有重要意义.本组患者高危因素为高白细胞计数及Ph染色体阳性.     

成人急性淋巴细胞白血病的化疗及预后因素分析

目的 分析成人急性淋巴细胞白血病(ALL)的临床特点,比较不同化疗方案组患者的疗效,探讨影响长期生存的因素.方法 回顾性分析1998年6月至2005年12月住院治疗的成人ALL患者149例.采用SPSS11.5统计软件分析有关数据.结果 ①133例患者进行了免疫表型分析,其中B细胞表型118例(88.7%),T细胞表型15例(11.3%).有染色体核型结果的患者105例,正常核型40例(38.1%),异常核型65例(61.9%).②按诱导治疗方案不同将治疗满4周的患者分为VDCP、VDLP、VDCLP三组,诱导治疗总完全缓解(CR)率为93.7%.三组患者诱导治疗1个疗程结束时CR率分别为80.8%、92.3%、81.4%,差异无统计学意义(P=0.618).包含和不包含门冬酰胺酶的诱导方案诱导治疗结束时CR率分别为95.5%和92.1%,差异无统计学意义(P=0.566).患者中位无病生存(DFS)期为12(1～74)个月,中位总生存(OS)期为17.5(1～97)个月.三组患者3年及5年DFS率分别为18.5%和14.8%、24.7%和9.9%、39.5%和39.5%,组间差异有统计学意义(P=0.0066).③通过COX回归模型分析显示患者就诊时年龄＞40岁、WBC＞40×109/L、染色体t(9;22)及巩固治疗不足4个疗程为预后不良因素.结论 成人ALL免疫表型检测以B-ALL为主,染色体核型变化较大.多数患者在接受4或5种药物联合的诱导方案治疗后可获CR;用门冬酰胺酶不影响诱导治疗CR率,但可提高患者的DFS和OS率.染色体核型异常影响患者生存情况.充分的巩固强化治疗对延长生存期必不可少.就诊时的年龄、白细胞计数、染色体核型检查结果及巩固治疗疗程数为影响生存的预后因素.     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.