第二型慢性鼻及鼻竇炎之次分類：中心軸過敏性疾病

Central Compartment Atopic Disease: A New Subgroup of Type II Chronic Rhinosinusitis

廖俊綱(Chun-Kang Liao) ； 葉德輝(Te-Huei Yeh)

《台灣耳鼻喉頭頸外科雜誌》 57卷2期 (2022/06) Pp. 67-71

https://doi.org/10.6286/jtohns.202206_57(2).067

摘要

隨著鼻科學基礎研究的蓬勃發展，對於慢性鼻及鼻竇炎的病理免疫學，近幾年有長足的進步；從以形態學上併息肉及無息肉的二分法，演變成以內因型（endotype）為主的分類，依據不同機轉及臨床特點的慢性鼻竇炎提出新的分類與治療策略，成為個人化精準醫療的最佳展現。歐洲鼻科醫學會鼻及鼻竇炎治療指引EPOS2020，在區分第二型慢性鼻及鼻竇炎的架構下，提出了中心軸過敏性疾病（central compartment atopic disease, CCAD）新的次分類。典型個案在內視鏡檢查中，可看到鼻及鼻竇腔中心軸區發炎／息肉樣變化；影像檢查，呈現特有的black halo sign，顯現中心軸區的病灶而週邊的鼻竇正常。其發生原因推測可能與吸入性的過敏原或刺激物引起的免疫反應有關。本文將介紹中心軸過敏性疾病，並回顧國外與本土文獻，以期耳鼻喉科醫師能熟悉此新的慢性鼻及鼻竇炎分類。

關鍵字

chronic rhinosinusitis ； central compartment atopic disease ； European Position Paper on Rhinosinusitis and Nasal Polyps 2020（慢性鼻及鼻竇炎 ； 中心軸過敏性疾病 ； 2020年歐洲鼻及鼻竇炎及鼻息肉治療指引）

並列摘要

Great progress in rhinology research, especially in the pathophysiology and immunology of chronic rhinosinusitis (CRS), has been observed in recent years. Previously CRS was classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Now, we utilize endotypes as the cornerstone for CRS classification. Based on different clinical features and the mechanism of CRS, clinicians can provide new treatment strategies. This has resulted in the realization of personalized medicine. According to the European Position Paper on rhinosinusitis and nasal polyps 2020 (EPOS 2020), a new subgroup of type II chronic CRS, central compartment atopic disease (CCAD) was identified. It is characterized by central compartment (including middle turbinate, superior turbinate and posterior-superior nasal septum) inflammation and is highly associated with inhalant allergens. Through nasal endoscopy, we can identify edematous or polypoid changes of the middle turbinate in CCAD patients. The typical radiologic pattern on computed tomography shows a ＂black halo sign＂, which means the central soft tissue is thickening with the peripheral areas spared. Here, we provide a brief review of CCAD to help Otolaryngologists in Taiwan to become familiar with this new CRS disease expression.

並列關鍵字

chronic rhinosinusitis ； central compartment atopic disease ； European Position Paper on rhinosinusitis and nasal polyps 2020