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免疫调节剂治疗鼻部炎症性疾病专家共识(2023，深圳)

Expert consensus on immunomodulatory drugs for nasal inflammatory diseases (2023,Shenzhen)

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【作者】 杨贵； 廖芸； 张维天； 余少卿； 杨钦泰； 王向东； 陈建军； 孟娟； 孟粹达； 许元腾； 孙悦奇； 许成利； 王英； 杨玉成； 刘锋； 孙娜； 赵可庆； 唐隽； 杨艳莉； 陆美萍； 邱前辉； 王洪田； 喻国冻； 安云芳； 左可军； 石照辉； 叶惠平； 孙斌； 孙亚男； 曾明； 许昱； 巴罗； 张天虹； 顾瑜蓉； 王天生； 叶菁； 谢志海； 洪海裕； 魏欣； 徐睿； 李勇； 李华斌；

【Author】 YANG Gui;LIAO Yun;ZHANG Weitian;XU Shaoqing;YANG Qintai;WANG Xiangdong;CHEN Jianjun;MENG Juan;MENG Cuida;XU Yuanteng;SUN Yueqi;XU Chengli;WANG Ying;YANG Yucheng;LIU Feng;SUN Na;ZHAO Keqing;TANG Juan;YANG Yanli;LU Meiping;QIU Qianhui;WANG Hongtian;YU Guodong;AN Yunfang;ZUO Kejun;SHI Zhaohui;YE Huiping;SUN Bin;SUN Yanan;ZENG Ming;XU Yu;BA Luo;ZHANG Tianhong;GU Yurong;WANG Tiansheng;YE Jing;XIE Zhihai;HONG Haiyu;WEI Xin;XU Rui;LI Yong;LI Huabin;Department of Otolaryngology Head and Neck Surgery & Department of Allergy,Shenzhen Longgang Central Hospital;Department of Otolaryngology Head and Neck Surgery,Sixth People’s Hospital,Shanghai Jiaotong University;Department of Otolaryngology Head and Neck Surgery,Tongji Hospital of Tongji University;Department of Otolaryngology Head and Neck Surgery & Department of Allergy,the Third Affiliated Hospital of Sun Yat-sen University;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University;Department of Otolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology;Department of Otolaryngology Head and Neck Surgery,West China Hospital,Sichuan University;Department of Otolaryngology Head and Neck Surgery,China-Japan Union Hospital of Jilin University;Department of Otolaryngology,the First Affiliated Hospital of Fujian Medical University;Department of Otolaryngology,the Seventh Affiliated Hospital of Sun Yat-sen University;Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Guangxi Medical University;Department of Rhinology,the First Affiliated Hospital of Zhengzhou University;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Chongqing Medical University;Department of Otolaryngology,Huadong Hospital Affiliated to Fudan University;Department of Otolaryngology,Affiliated Ophthalmology and Otolaryngology Hospital of Fudan University;Department of Otolaryngology Head and Neck Surgery,First People’s Hospital of Foshan City;Department of Otolaryngology,the First Affiliated Hospital of Kunming Medical University;Department of Otolaryngology,the First Affiliated Hospital of Nanjing Medical University;Department of Otolaryngology Head and Neck Surgery,Guangdong Provincial People’s Hospital;Department of Allergy,Beijing Shijitan Hospital,Capital Medical University;Department of Otolaryngology,Guizhou Medical University;Department of Otolaryngology,the Second Hospital of Shanxi Medical University;Otorhinolaryngology Hospital,the First Affiliated Hospital of Sun Yat-Sen University;Department of Otolaryngology Head and Neck Surgery&Department of Allergy,the Third Affiliated Hospital of Sun Yat-sen University;Department of Otolaryngology,Guizhou Province Hospital;Otorhinolaryngology Head and Neck Surgery Hospital,the Second Affiliated Hospital of Xi’an Jiaotong University;Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Harbin Medical University;Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology;Department of Otolaryngology Head and Neck Surgery,Renmin Hospital,Wuhan University;Department of Otolaryngology,the People’s Hospital of Tibet Autonomous Region;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Harbin Medical University;Department of Otolaryngology Head and Neck Surgery,Third Xiangya Hospital,Central South University;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Nanchang University;Department of Otolaryngology Head and Neck Surgery,Xiangya Hospital,Central South University;Allergy Center,Department of Otolaryngology,the Fifth Affiliated Hospital of Sun Yat-sen University;Otolaryngology Hospital,Hainan General Hospital;Department of Otolaryngology Head and Neck Surgery,Hangzhou First People’s Hospital Affiliated to Zhejiang University School of Medicine;Chinese Rhinopathy Research Cooperation Group;

【通讯作者】 杨贵;魏欣;徐睿;李勇;李华斌;

【机构】 深圳市龙岗中心医院耳鼻咽喉头颈外科和变态反应/过敏科； 上海交通大学附属第六人民医院耳鼻咽喉头颈外科； 同济大学附属同济医院耳鼻咽喉头颈外科； 中山大学附属第三医院耳鼻咽喉头颈外科和变态反应/过敏科； 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科； 华中科技大学同济医学院附属协和医院耳鼻咽喉科； 四川大学华西医院耳鼻咽喉头颈外科； 吉林大学中日联谊医院耳鼻咽喉头颈外科； 福建医科大学附属第一医院耳鼻咽喉科； 中山大学附属第七医院耳鼻咽喉科； 广西医科大学第二附属医院耳鼻咽喉头颈外科； 郑州大学第一附属医院鼻科； 重庆医科大学附属第一医院耳鼻咽喉头颈外科； 复旦大学附属华东医院耳鼻咽喉科； 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科； 佛山市第一人民医院耳鼻咽喉头颈外科； 昆明医科大学第一附属医院耳鼻咽喉科； 南京医科大学第一附属医院耳鼻咽喉科； 广东省人民医院耳鼻咽喉头颈外科； 首都医科大学附属北京世纪坛医院变态反应科； 贵州医科大学附属医院耳鼻咽喉科； 山西医科大学第二医院耳鼻咽喉科； 中山大学附属第一医院耳鼻咽喉科医院； 贵州省人民医院耳鼻咽喉科； 西安交通大学第二附属医院耳鼻咽喉头颈外科病院； 哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科； 华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科； 武汉大学人民医院耳鼻咽喉头颈外科； 西藏自治区人民医院耳鼻咽喉科； 哈尔滨医科大学附属第一医院耳鼻咽喉头颈外科； 中南大学湘雅三医院耳鼻咽喉头颈外科； 南昌大学附属第一医院耳鼻咽喉头颈外科； 中南大学湘雅医院耳鼻咽喉头颈外科； 中山大学附属第五医院过敏反应中心耳鼻咽喉科； 海南省人民医院耳鼻咽喉科医院； 浙江大学医学院附属杭州市第一人民医院耳鼻咽喉头颈外科； 中国鼻病研究协作组；

【摘要】 鼻部炎症性疾病临床主要包括变应性鼻炎(AR)、非变应性鼻炎(NAR)和慢性鼻窦炎(CRS),其发病机制尚未完全阐明，涉及遗传学、免疫调节、炎症介质、环境因素、微生物群状态等多方面，传统药物治疗后部分患者症状仍无法缓解或出现不必要的副作用，且容易反复发作或呈慢性持续状态，因其发病多与免疫失衡相关，免疫调节是一个有效的治疗方案。近年来，免疫调节剂的品种和应用越来越广泛，主要包括化学合成制剂、生物制剂、人和动物免疫系统的产物、中药及其制剂等。但免疫调节剂治疗鼻部炎症疾病缺乏高水平的循证医学证据，使用尚不规范，因此，我们特组织该领域有经验的中青年鼻科专家，基于临床经验和循证医学证据制定了免疫调节剂治疗鼻部炎症性疾病专家共识，本共识从鼻部炎症性疾病发病机制角度出发，系统总结了鼻炎及CRS常用免疫调节剂的免疫作用机制、临床研究证据、适应证、用法用量及注意事项等，以供临床医生在选择和应用免疫调节剂时参考。

【Abstract】 The clinical entity of nasal inflammatory diseases mainly includes allergic rhinitis, non-allergic rhinitis and chronic rhinosinusitis. The pathogenesis has not been fully clarified, involving genetics, immune regulation, inflammatory mediators, environmental factors, microbial community status, and other aspects. Conventional drug treatment may fail to relieve symptoms or even cause side effect in some patients.And the patients are prone to recurrent the disease or be in chronic persistent state. Considering its pathogenesis mostly related to immune imbalance, immune regulation is an effective treatment plan. Recently, the variety and application of immunomodulatory drugs have become more and more extensive, including chemically synthesized molecules, biological agents, products of human and animal immune systems, and traditional Chinese medicine. However, the application of immunomodulatory drugs in the treatment of nasal inflammatory diseases is not standardized due to the lack of high-level evidence-based medical evidences. Therefore, we intentionally organized young and middle-aged nasal experts with experience in this field to develop an expert consensus on immunomodulatory drugs for the treatment of nasal inflammatory diseases based on clinical experience and evidence-based medical evidence. This consensus systematically summarizes the immune mechanisms, clinical research evidence, indications, usage and dosage, as well as precautions of immunomodulatory drugs for rhinitis and chronic rhinosinusitis, so as to provide a reference for clinical selection and application of immunomodulatory drugs.

【关键词】 变应性鼻炎； 非变应性鼻炎； 慢性鼻窦炎； 免疫调节剂； 专家共识；
【Key words】 Allergic rhinitis； Non-allergic rhinitis； Chronic rhinosinusitis； Immunomodulatory drugs； Expert consensus；
【基金】 国家自然科学基金杰出青年基金(81725004);国家自然科学基金(81870706,81670901,81873689,81873690,81870700,82071014,82171104,82171119,82171120,82101201,82260219,82071018);上海市科委项目(20MC920200,19XD4010000);上海市促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR4090);上海申康医学发展中心临床科技创新项目(SHDC12019X07);上海市卫生健康委先进适宜技术推广项目(2019SY071);四川省科技厅重点研发项目(2021YFS0036);四川省人社厅留学人员回国科技活动项目择优资助(川人社函[2020]291号);成都市科技局重点产业研发支撑计划(2021-YF05-00473-SN);福建省自然科学基金面上项目(2020J01981);福建省卫生教育联合攻关计划项目(2019-wj-25);广东省自然科学基金面上项目(2022A1515012617,2022A1515012394);深圳市科技计划项目(JCYJ20210324121413037)
  • 【文献出处】 中国耳鼻咽喉颅底外科杂志 ,Chinese Journal of Otorhinolaryngology-Skull Base Surgery , 编辑部邮箱 ,2023年01期
  • 【分类号】R765.21
  • 【下载频次】249
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