Chapter 7: Nasal polyps.
Chapter 7: Nasal polyps.
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DOI：
10.2500/aap.2012.33.3537
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发表时间：
2012-05-01
影响因子：
2.8
通讯作者：
Peters, Anju T
中科院分区：
文献类型：
--
作者：
Georgy, Mary S;Peters, Anju T
鼻息肉是由慢性粘膜炎症引起的副鼻窦粘膜的炎性生长物，通常发生在中鼻道和筛窦区域。鼻息肉的主要症状是常年性鼻塞、鼻塞、嗅觉丧失或嗅觉减退。与没有鼻息肉的慢性鼻窦炎（CRS）患者不同，鼻息肉患者通常不会抱怨这些症状。鼻息肉在鼻腔内表现为透明的、淡灰色的生长物，与粉红色或肿胀的邻近粘膜形成对比。鼻息肉更常见于持续性哮喘、阿司匹林加重的呼吸道疾病（AERD）、CRS和囊性纤维化患者。儿童鼻息肉应评估囊性纤维化。变应性鼻炎和纤毛运动障碍也可能与鼻息肉有关。鼻息肉中活化的嗜酸性粒细胞、肥大细胞和IgE的数量增加。葡萄球菌超抗原可能在鼻息肉中观察到的Th2型慢性嗜酸性粒细胞炎症中发挥作用。已经描述了鼻息肉中上皮屏障功能障碍导致抗微生物蛋白水平降低。局部鼻用类固醇是治疗的首选。他们显着减少息肉的大小，鼻塞，鼻溢液，并增加鼻腔气流。可能需要短期口服类固醇以减少息肉大小，然后用鼻内类固醇维持治疗。手术是保留的情况下，息肉造成严重阻塞，复发性鼻窦炎，并为病人谁已失败的药物治疗。阿司匹林脱敏可能减少AERD患者对息肉切除术和鼻窦手术的需求。
Nasal polyps are inflammatory outgrowths of paranasal sinus mucosa caused by chronic mucosal inflammation that typically arise from the middle meatus and ethmoid region. The main symptoms of nasal polyps are perennial nasal congestion, nasal obstruction, and anosmia or hyposmia. Unlike patients with chronic rhinosinusitis (CRS) without nasal polyps who present with headache and facial pain, patients with nasal polyps typically do not complain of those symptoms. Nasal polyps appear as semitranslucent, pale gray growths in the nasal cavity in contrast to pink or erythematous adjacent mucosa. Nasal polyps occur more frequently in patients with persistent asthma, aspirin-exacerbated respiratory disease (AERD), CRS, and cystic fibrosis. Children with nasal polyps should be evaluated for cystic fibrosis. Churg-Strauss syndrome and ciliary dyskinesia also may be associated with nasal polyps. Nasal polyps have increased numbers of activated eosinophils, mast cells, and IgE. Staphylococcal superantigens may play a role in the Th2 type of chronic eosinophilic inflammation observed in nasal polyps. Dysfunction of the epithelial barrier in nasal polyps causing reduced levels of antimicrobial proteins has been described. Topical nasal steroids are the treatment of choice. They significantly decrease polyp size, nasal congestion, rhinorrhea, and increase nasal airflow. Short courses of oral steroids may be needed to reduce polyp size followed by maintenance therapy with intranasal steroids. Surgery is reserved for cases when polyps cause severe obstruction, recurrent sinusitis, and for patients who have failed medical therapy. Aspirin desensitization may decrease the requirement for polypectomies and sinus surgery in patients with AERD.