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)

作　　者：杨贵[1] 廖芸 张维天[2] 余少卿[3] 杨钦泰[4] 王向东[5] 陈建军[6] 孟娟[7] 孟粹达[8] 许元腾[9] 孙悦奇[10] 许成利 王英[12] 杨玉成[13] 刘锋[7] 孙娜 赵可庆 唐隽[16] 杨艳莉 陆美萍[18] 邱前辉[19] 王洪田 喻国冻 安云芳[22] 左可军[23] 石照辉 叶惠平 孙斌[25] 孙亚男[26] 曾明[27] 许昱[28] 巴罗[29] 张天虹[30] 顾瑜蓉 王天生[31] 叶菁 谢志海[33] 洪海裕[34] 魏欣[35] 徐睿[23] 李勇[36] 李华斌 中国鼻病研究协作组 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;Chinese Rhinopathy Research Cooperation Group(Department of Otolaryngology Head and Neck Surgery&Department of Allergy,Shenzhen Longgang Central Hospital,Shenzhen 518116,China;Department of Otolaryngology Head and Neck Surgery,Sixth People’s Hospital,Shanghai Jiaotong University,Shanghai 200233,China;Department of Otolaryngology Head and Neck Surgery,Tongji Hospital of Tongji University,Shanghai 200065,China;Department of Otolaryngology Head and Neck Surgery&Department of Allergy,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Otolaryngology Head and Neck Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Otolaryngology Head and Neck Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,China;Department of Otolaryngology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350004,China;Department of Otolaryngology,the Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518170,China;Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;Department of Rhinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Chongqing Med

机构地区：[1]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,广东深圳518116 [2]上海交通大学附属第六人民医院耳鼻咽喉头颈外科,上海200233 [3]同济大学附属同济医院耳鼻咽喉头颈外科,上海200065 [4]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,广东广州510630 [5]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [6]华中科技大学同济医学院附属协和医院耳鼻咽喉科,湖北武汉430022 [7]四川大学华西医院耳鼻咽喉头颈外科,四川成都610041 [8]吉林大学中日联谊医院耳鼻咽喉头颈外科,吉林长春130033 [9]福建医科大学附属第一医院耳鼻咽喉科,福建福州350004 [10]中山大学附属第七医院耳鼻咽喉科,广东深圳518107 [11]广西医科大学第二附属医院耳鼻咽喉头颈外科,广西南宁530007 [12]郑州大学第一附属医院鼻科,河南郑州450052 [13]重庆医科大学附属第一医院耳鼻咽喉头颈外科,重庆400016 [14]复旦大学附属华东医院耳鼻咽喉科,上海200040 [15]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031 [16]佛山市第一人民医院耳鼻咽喉头颈外科,广东佛山528000 [17]昆明医科大学第一附属医院耳鼻咽喉科,云南昆明650032 [18]南京医科大学第一附属医院耳鼻咽喉科,江苏南京210029 [19]广东省人民医院耳鼻咽喉头颈外科,广东广州510080 [20]首都医科大学附属北京世纪坛医院变态反应科,北京100038 [21]贵州医科大学附属医院耳鼻咽喉科,贵州贵阳550001 [22]山西医科大学第二医院耳鼻咽喉科,山西太原030001 [23]中山大学附属第一医院耳鼻咽喉科医院,广东广州510080 [24]贵州省人民医院耳鼻咽喉科,贵州贵阳550002 [25]西安交通大学第二附属医院耳鼻咽喉头颈外科病院,陕西西安710004 [26]哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科,黑龙江哈尔滨150001 [27]华中科技大学同济医学院附属�

出　　处：《中国耳鼻咽喉颅底外科杂志》2023年第1期1-14,共14页Chinese Journal of Otorhinolaryngology-skull Base Surgery

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)。

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。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 

分 类 号：R765.2[医药卫生—耳鼻咽喉科]