慢性副鼻腔炎の予後不良因子

Abstract

Chronic rhinosinusitis (CRS) is a commonly encountered chronic disease that is treated with medications (e.g., corticosteroids or macrolides) and by endoscopic sinus surgery. Although there has been an increase in the cure rate of CRS recently following the introduction of these treatments, a substantial number of patients still have a poor prognosis. Nasal polyps immediately recur after surgery in cases of CRS that present with severe eosinophilic infiltration. We refer to CRS with eosinophilic infiltration as eosinophilic CRS (ECRS). CRS is known to have a multifactorial etiology. Even with the best ESS technique, the clinical course of the disease after the surgery can be challenging on account of several factors, including the postoperative management and the type and the extent of the disease, which may contribute to the natural course of the disease and the surgical outcomes. It has been reported that nasal polyps and asthma are linked by shared inflammation of the entire airway mucosa, and particularly by increased eosinophil infiltration of the mucosa. In addition, mucosal eosinophilia is frequently associated with more severe disease and with recurrence of polyps after surgery. Furthermore, CRS patients with aspirin-intolerant asthma often have particularly severe asthma that is associated with rhinorrhea and recurrent nasal polyps. These findings suggest that concomitant asthma may contribute to the pathophysiology of CRS. Our study revealed that women with CRS have a poorer prognosis than men with CRS. Future studies are needed to elucidate the mechanisms that drive the gender-related difference in disease severity, paving the way for the development of personalized treatments for CRS based on the gender of the patient.