儿童鼻窦炎的临床诊疗进展

儿童鼻窦发育和免疫能力均不够成熟,鼻窦炎临床特征和转归与成人患者差异显著,且与其他气道病变如变应性鼻炎、腺样体肥大及分泌性中耳炎及扁桃体炎、支气管哮喘等之间存在密切联系,容易出现眶内及颅内并发症,需要引起重视。论文主要讨论儿童慢性鼻窦炎的发病机制、诊断及诊疗进展,重点对药物治疗和手术治疗进行阐述,希冀对耳鼻喉科医生诊疗此类儿童疾病提供参考。     

生物制剂治疗支气管哮喘的研究进展

支气管哮喘是呼吸系统常见的气道慢性炎症性疾病，吸入皮质激素是其主要治疗策略。随着哮喘发病机制的深入研究，发现气道炎症类型不同，吸入激素治疗的反应不同。针对气道炎症反应过程中的炎性介质，已经开发了多种生物制剂。临床随机对照研究中，严重嗜酸粒细胞性哮喘患者从中获益，部分临床疗效存在争议。儿童用药的疗效和安全性及药物对疾病产生的长期影响还需进一步研究证实。     

儿童慢性鼻窦炎伴发反应性呼吸道疾病

鼻窦炎可能是难以控制的儿童慢性反应性呼吸道疾病(如哮喘)的激发因素。经选择适当抗生药物治疗鼻窦炎2～5周,可显著改善这种反应性下呼吸道病变。本文报告48例鼻窦炎伴发哮喘的儿童,着重对鼻窦炎治疗前后的临床症状和放射学等变化作了比较。治疗前,全部儿童每年都有持续3个月以上的哮鸣和咳嗽病史;瓦氏位     

2型固有淋巴细胞在慢性鼻窦炎中的作用及调节机制研究进展

慢性鼻窦炎是一种发生于鼻窦黏膜的慢性炎症疾病,主要表现为鼻塞、流涕等鼻部症状,其次是头面部胀痛、嗅觉减退或丧失,病程不少于12星期,常合并哮喘及慢性阻塞性肺疾病等呼吸道疾病。作为一种多因素病因的炎症性疾病,涉及免疫系统和上皮屏障,受微生物组群、环境和遗传因素的影响。目前其发病机制尚未明确。固有淋巴细胞是T淋巴细胞的先天对应细胞,缺乏遗传因素重组产生的适应性抗原受体。其中2型固有淋巴细胞(group 2 innate lymphoid celles, ILC2s)激活后释放大量2型细胞因子,与Th2免疫反应密切相关。论文就慢性鼻窦炎伴鼻息肉中ILC2s的作用及其调节机制,尤其是与调节性T细胞之间的相互作用进行综述。     

慢性鼻窦炎合并哮喘研究进展[综述]

慢性鼻窦炎（chronic rhinosinusitis，CRS）和哮喘（asthma，AS）分别是上、下呼吸道常见的慢性炎症性疾病。人群中有7%～71%的CRS患者合并AS（CRS+AS），其症状严重且更容易复发，对生活质量影响更大，治疗也最具挑战性。联合气道学说认为上、下气道有相似的炎症特征及发病机制，并提出“同一气道，同一疾病”的观点。CRS与AS之间的关系目前尚未有明确的解释，并且CRS+AS的炎症特征和发病机制尚不完全清楚，临床上也缺少最佳的治疗方案。本文就CRS+AS的最新研究进展做一综述，为进一步研究CRS+AS可能的致病机制和治疗策略提供参考。     

儿童鼻窦炎

鼻窦炎是儿童的常见病和多发病,其发病与多种因素相关,可伴随其它疾病出现于儿童人群中,亦可作为全身性疾病和耳鼻咽喉科的表现之一。本文就儿童鼻窦炎发病机理、诊断及治疗作一综述。     

变应性鼻炎

变应性鼻炎在成人和儿童中都是常见病，增加病人经济负担、严重影响患生活质量，且常同时伴发哮喘、鼻一鼻窦炎和分泌性中耳炎等上、下气道疾病，积极治疗变应性鼻炎将显改善伴发病的疗效。本系主要为1995-2002年间42篇献的综述，着重讨论了变应性鼻炎造成的负担、相关病理生理学知识及其与伴发病的关系。     

细胞焦亡在慢性气道炎症性疾病中的研究进展

细胞焦亡是由半胱氨酸蛋白酶介导的促炎性的细胞程序性死亡,包括caspase-1介导的经典途径和caspase-4/5/11介导的非经典途径。细胞焦亡在慢性气道炎症性疾病的发生发展过程中发挥重要作用,已成为慢性气道炎症性疾病发病机制的研究热点。论文介绍细胞焦亡的概念,及其在变应性鼻炎、慢性鼻窦炎、哮喘和慢性阻塞性肺疾病中的研究进展,可能为治疗该类疾病提供新思路。     

变应性鼻炎

变应性鼻炎在成人和儿童中都是常见病,增加病人经济负担、严重影响患者生活质量,且常同时伴发哮喘、鼻-鼻窦炎和分泌性中耳炎等上、下气道疾病,积极治疗变应性鼻炎将显著改善伴发病的疗效.本文系主要为1995～2002年间42篇文献的综述,着重讨论了变应性鼻炎造成的负担、相关病理生理学知识及其与伴发病的关系.     

抗IgE单克隆抗体治疗难治性鼻窦炎伴鼻息肉三例

鼻息肉是鼻腔和鼻窦黏膜最常见的慢性变态反应相关疾病之一,难治性鼻窦炎伴鼻息肉常合并哮喘,手术和药物治疗都很难控制病情。奥马珠单克隆抗体是人源性IgE单克隆抗体,国外已有应用IgE单克隆抗体治疗鼻息肉,特别是哮喘合并鼻息肉的报道。本研究对3例哮喘合并慢性鼻窦炎伴鼻息肉（CRSwNP）的患者采用奥马珠单克隆抗体治疗,随访1...     

FeNO在呼吸道炎性疾病中临床应用

呼吸道炎症是哮喘和其他肺部疾病病理生理的一个核心过程。炎症细胞产生细胞因子，这些细胞因子促使上皮细胞的可诱导一氧化氮合成酶表达，致使一氧化氮产生。2011年美国胸科学会指南指出FeNO可作为呼吸道炎症嗜酸性粒细胞的标志物。目前研究显示FeNO值被用于评估和管理呼吸道炎症性疾病。FeNO测定在哮喘中的应用已经日渐成熟，目前开始应用于儿童上呼吸道道炎性疾病（鼻-鼻窦炎、鼻息肉、变应性鼻炎、阻塞性睡眠呼吸暂停低通气综合征）的诊断和治疗。FeNO在判断表达呼吸道炎症的类型和指导治疗方面有独特的优势，且在小儿呼吸道炎性疾病中的作用还是值得期待的。     

Does mucosal remodeling in chronic rhinosinusitis result in irreversible mucosal disease?

Mucosal remodeling in the sinuses is a recently described phenomenon in which the mucosa undergoes potentially irreversible changes as a result of ongoing underlying inflammatory processes. Research into remodeling that occurs in the bronchial airways in asthmatic patients has led to modification of asthma treatment guidelines. However, remodeling in the sinuses has still not led to changes in current medical or surgical management of chronic rhinosinusitis. Upper airway remodeling constitutes a new area of research that poses many unanswered clinical questions and may potentially alter the management of patients with severe chronic rhinosinusitis.     

Eosinophilic otitis media; state-of-the-art diagnosis and treatment

Eosinophilic otitis media (EOM) is an intractable otitis media with highly viscous middle ear effusion and is usually associated with bronchial asthma. Since the diagnostic criteria of EOM were established in 2011, the concept of EOM has been known worldwide. EOM is caused by Type 2 inflammation in the respiratory tract, similar to bronchial asthma and eosinophilic rhinosinusitis. With the appreciation of Type 2 inflammatory diseases, EOM is no longer considered to be a rare disease and should be specifically treated to improve quality of life. The diagnosis of EOM needs to be reconsidered because many reports have described varying pathogenesis and mechanisms of rare middle ear conditions. Systemic and topical administration of corticosteroids is presently the most effective treatment to control EOM. However, EOM treatments are developing because various biologics have been used to treat patients with bronchial asthma with and without eosinophilic rhinosinusitis and EOM. Surgical intervention is also no longer contraindicated with the use of biologics. These advances represent the beginning of a new stage of basic and clinical research for EOM. This review focuses on the diagnosis and treatment of EOM based on the most recent advances regarding EOM.     

Relationship between inflammation of upper and lower respiratory airways

Dysfunction of the upper and lower airways frequently coexists, and they appear to share key elements of pathogenesis. Data from epidemiologic studies indicate that nasal symptoms are experienced by as many as 78% of patients with asthma and that asthma is experienced by as many as 38% of patients with allergic rhinitis. Among patients with nasal polyps 27-51% have asthma. Polyps of nasal mucosa usually exacerbates symptoms of concomitant asthma. Studies also have identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma. Patients with allergic rhinitis and no clinical evidence of asthma commonly exhibit nonspecific bronchial hyperresponsivenes. The mechanisms upper and lower airway dysfunction are under investigation. They include nasal-bronchial reflex, mouth breathing caused by nasal obstruction, and pulmonary aspiration of nasal contents. Nasal allergen challenge results in increases in lower airway reactivity within 30 minutes, suggesting a neural reflex. Improvements in asthma associated with increased nasal breathing may be the result of superior humidification, warming of inspired air, and decreased inhalation of airborne allergens. Postnasal drainage of inflammatory cells during sleep also may affect lower airway responsiveness. The effective management of allergic rhinitis relieves symptoms of asthma. A link between allergic rhinitis and asthma is evident from epidemiologic, pathophysiologic, and clinical studies. The development of differential diagnosis of rhinitis has multiplied their present classifications. This article presents classifications of rhinitis connected with lower airways dysfunction.     

南京市儿童鼻-鼻窦炎性疾病与支气管哮喘相关性流行病学调查

目的:了解儿童鼻-鼻窦炎性疾病与支气管哮喘相关性流行病学特征。方法:2004年3~9月,用“南京市儿童呼吸道疾病问卷调查表”,对随机选择的南京市7所小学3年级学生(9~10岁)进行问卷调查。根据诊断标准对问卷中有相关症状者,由专科医师进行集中检查,结果进行统计学处理。结果:共发放问卷调查表1087份,回收989份,应答率91%,有效答卷942份。9~10岁儿童慢性鼻-鼻窦炎(慢性鼻-鼻窦炎组)发病率为8.8%,其中男9.1%,女8.5%;变应性鼻炎(变应性鼻炎组)发病率为5.1%,其中男5.6%,女4.6%,两者发病率与性别差异无统计学意义(P>0.05)。支气管哮喘总发病率为5.3%,其中男6.8%,女3.7%,男、女发病率差异有统计学意义(χ2=4.518,P<0.05)。慢性鼻-鼻窦炎并发支气管哮喘发病率为19.3%,变应性鼻炎并发支气管哮喘发病率为39.6%,均较无鼻疾病者(无鼻病组)的发病率(1.8%)高,支气管哮喘在慢性鼻-鼻窦炎和变应性鼻炎组中发病率明显升高,均差异有统计学意义(均P<0.01)。结论:支气管哮喘在鼻-鼻窦炎性疾病儿童中的发病率明显升高。     

Pulmonary function in patients with eosinophilic chronic rhinosinusitis

Objective

There is a close relationship between upper and lower respiratory tract diseases. Chronic rhinosinusitis patients frequently have lung diseases including asthma and chronic obstructive pulmonary disease. Eosinophilic chronic rhinosinusitis is considered a refractory and intractable subtype of chronic rhinosinusitis. However, there has been no report on pulmonary function in patients with eosinophilic chronic rhinosinusitis. The purpose of this study is to examine the pulmonary function in eosinophilic chronic rhinosinusitis patients and non-eosinophilic chronic rhinosinusitis patients, and evaluate clinical factors associated with the pulmonary function of these patients.

上皮源性细胞因子在共同气道疾病中的作用及其研究进展

在"一个气道一种疾病"的概念下,上下气道炎症性疾病通常是并存的,整个气道可以看作一个器官.上呼吸道和下呼吸道表面覆盖呼吸道上皮,在免疫监视和调节中起着至关重要的作用,是抵御各种病原微生物、变应原和组织损伤的第一道防线.近年来,大量研究认为上皮源性细胞因子,如白细胞介素(IL)-25、IL-33和胸腺基质淋巴细胞生成素(...