度普利尤单抗治疗慢性鼻窦炎伴鼻息肉的疗效分析

Efficacy of duplizumab for the treatment of chronic rhinosinusitis with nasal polyps

摘要:

目的 分析临床中IL-4Rα单克隆抗体(度普利尤单抗)治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的疗效。方法 回顾性分析2020年8月—2021年4月使用度普利尤单抗治疗4例CRSwNP患者前后的临床疗效、实验室数据、主观及客观评分以及不良事件等情况，初步评价度普利尤单抗治疗CRSwNP的效果。结果 对4例CRSwNP患者随访4个月。在接受度普利尤单抗治疗前，4例患者慢性鼻-鼻窦炎急性加重次数平均为(3.25±1.50)次/年，在随访期间4例患者均未出现慢性鼻-鼻窦炎急性加重，其中3例患者的鼻窦炎症状得到完全控制。度普利尤单抗治疗前4例患者平均鼻腔鼻窦结局测试-22 (SNOT-22)、宾夕法尼亚大学的嗅觉测试(UPSIT)及副鼻窦CT扫描Lund-Mackay评分分别为52.00±9.42、7.25±1.26、14.50±5.45;治疗4个月后上述评分分别为8.25±5.74、29.25±6.34，7.00±6.38，治疗前后对比差异均具有统计学意义(P<0.05)。使用单抗治疗后4例患者平均口服糖皮质激素(OCS)量为(5.00±7.07)mg/d，对比治疗前(18.75±4.79) mg/d，差异具有统计学意义(P<0.05)。结论 通过特异性抑制白介素-4(IL-4)和白介素-13(IL-13)通路，度普利尤单抗可以显著改善CRSwNP患者鼻窦炎症状以及嗅觉水平，减少患者慢性鼻-鼻窦炎急性加重次数、鼻窦炎病变范围和全身糖皮质激素用量。

关键词:慢性鼻窦炎伴鼻息肉;度普利尤单抗;哮喘;2型炎症

Abstract:

Objective To analyze the therapeutic effect of interleukin(IL)-4Rα monoclonal antibody (duplizumab) for chronic sinusitis with nasal polyps (CRSwNP).Methods The clinical efficacy, laboratory data, subjective and objective scores as well as adverse events before and after treatment in 4 patients with CRSwNP treated with duplizumab in our hospital from Aug 2020 to April 2021 were retrospectively analyzed, and the effect of duplizumab for the treatment of CRSwNP was preliminarily evaluated.Results All the 4 patients were followed up for 4 months. Before duplizumab treatment, their average number of acute episodes of sinusitis was 3.25±1.50 times per year. During the follow-up period, none of them showed acute episode of chronic sinusitis symptoms, and sinusitis was completely controlled in 3. Before treatment, the average scores of sino-nasal outcome test-22 (SNOT-22), University of Pennsylvania smell identification test (UPSIT) and Lund-Mackay of paranasal sinuses CT were 52.00±9.42, 7.25±1.26 and 14.50±5.45 respectively. After 4 months of treatment, the above scores were 8.25±5.74, 29.25±6.34 and 7.00±6.38 respectively, which were statistically significant compared with those before treatment (P<0.05). The average dose of oral glucocorticoid in the 4 patients after duplizumab treatment was 5.00±7.07 mg/day, which was significantly lower than that before treatment (18.75±4.79mg/d) (P<0.05).Conclusion By specifically inhibiting IL-4 and IL-13 pathways, dupilumab can significantly improve sinusitis symptoms and olfactory level, reduce the number of acute episode of sinusitis symptoms, the lesion extent of sinusitis and systemic glucocorticoid dosage in patients with CRSwNP.

Key words:Duplizumab;Chronic sinusitis;Asthma;Type 2 inflammation