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鼻及鼻窦炎(rhinosinusitis)是一种全球性常见疾病,是指由鼻和鼻窦黏膜炎症反应所引发的一系列临床症状,如鼻塞、流涕、面部疼痛或胀痛以及嗅觉减退或丧失等。目前,我们对导致炎症发生和发展的病因学、病理生理学、治疗和转归等还不甚了解。慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)病程较长,许多患者对各种常规治疗不敏感,即使手术治疗后复发率也相当高,这给患者和临床医师都带来了很大的不便。在过去10～20年中,该研究领域的重点是探索导致CRS炎症反应的原因以及可以有效控制和预防炎症反应发生的方法。在众多研究结果中,以Ponikau博士为首的研究小组提出了一种由真菌,尤其是念珠菌(Alternaria)所引发的,以嗜酸细胞增多为主要病理表现的CRS炎症学说,其新颖之处在于念珠菌既不是通过IgE介导的变应性炎症反应,也不是感染途径,而是存在于鼻和鼻窦黏膜表面黏液层中的念珠菌通过特殊的免疫反应,促使嗜酸细胞从血管内移行出来并穿行通过黏膜组织,然后在黏液层中直接攻击真菌。这种反应的结果可导致嗜酸细胞活化、脱颗粒并释放毒性蛋白。这些蛋白对鼻和鼻窦黏膜上皮造成损伤,继之细菌通过受损的鼻窦黏膜入侵而继发细菌感染。他们的一系列研究结果曾发表于国际一流的耳鼻咽喉头颈外科学和免疫学专科杂志上,并在学术届引起了轰动,这一研究项目得到了包括美国最大科研基金会——美国国立卫生组织(National Institutes of Health,NIH)的赞助。尽管他们的研究成果具有很强的争议性,但仍对医学尤其是本学科研究领域注入了新思想、新概念和新活力。科学研究的关键是注重是事实,客观反映物质存在。因此,我们将Ponikau博士等撰写的文章推荐给本刊读者,希望能够起到抛砖引玉、激发本学科的科研创新。
Rhinosinusitis is a common global disease and refers to a series of clinical symptoms caused by inflammatory reaction of nasal and sinus mucosa such as stuffy nose, runny nose, facial pain or pain, and loss or loss of smell. At present, we do not yet understand the etiology, pathophysiology, treatment and outcome that lead to the occurrence and development of inflammation. Chronic rhinosinusitis (CRS) has a long course of treatment. Many patients are insensitive to various conventional therapies, and the relapse rate after surgery is quite high, which brings great inconvenience to patients and clinicians. In the past 10 to 20 years, the focus of this research area has been to explore the causes of the inflammation that cause CRS and the methods that can effectively control and prevent the occurrence of inflammatory reactions. Among the numerous findings, a team led by Dr. Ponikau proposed a CRS inflammatory theory triggered by fungi, particularly, Alternaria, with eosinophilia as its major pathology, which is novel in that Candida albicans neither through IgE-mediated allergic inflammation, nor is it the route of infection, but the presence of Candida in the mucus of the nasal and sinus mucosa through a special immune response to promote eosinophil migration from the blood vessels And through the mucosal tissue, and then directly attack the fungus in the mucus layer. The result of this reaction can lead to eosinophil activation, degranulation and release of toxic proteins. These proteins cause damage to the mucosal epithelium of the nose and sinuses, followed by bacterial infections secondary to the invasion of bacteria through the damaged sinous mucosa. A series of their results have been published in the world-class specialist in Otorhinolaryngology Head and Neck Surgery and Immunology and caused a sensation in the academic year, the research project has been including the largest research foundation in the United States - the United States National Health Organization (National Institutes of Health, NIH) sponsorship. Although their research results are highly controversial, they still inject new ideas, new concepts and new vitals into medicine, especially in the field of this discipline. The key to scientific research is to pay attention to the fact that objectively reflects the material existence. Therefore, we recommend articles written by Dr. Ponikau et al to our readers, hoping to be able to start a discussion and stimulate scientific research innovation in this subject.