鼻内镜手术前后鼻腔分泌液中血小板源性生长因子和肿瘤坏死因子α及透明质酸的变化

Secretion of platelet derived growth factor, tumour necrosis factor-α and hyaluronic acid into nasal fluid before and after sinus surgery

目的探讨鼻内镜手术前后鼻腔分泌液中血小板源性生长因子(plateletderivedgrowthfactor,PDGF)、肿瘤坏死因子α(tumournecrosisfactorα,TNFα)、透明质酸(hyaluronicacid,HA)的变化,研究鼻黏膜愈合情况的预测因素。方法用酶联免疫吸附试验(enzymelinkedimmunosorbertassay,ELISA)对22例行鼻内镜手术的鼻鼻窦炎鼻息肉患者术前、术后第1、4、8、12周鼻腔分泌液中PDGF、TNFα、HA的含量进行测定,同时测定22例健康者鼻腔分泌液中3种因子的含量作为对照,观察术后第1、4、8、12周术腔愈合情况,并与患者的性别、年龄、体重、分型分期、术前3种因子的含量之间进行Logistic回归分析。结果①鼻鼻窦炎鼻息肉患者术前鼻腔分泌液中3种因子的含量为:PDGF在正常范围内,TNFα高于对照组(P=0.034),HA明显比对照组低(P=0.003)。3种因子的含量均在术后升高,第1周达高峰(与对照组相比,PDGF、TNFα、HA的P值依次为0.000、0.020、0.038),而后逐渐下降,PDGF第12周降至正常(与对照组相比,P=0.087),TNFα第8周降至正常(与对照组相比,P=0.104),12周又出现了升高(与对照组相比,P=0.002),HA第4周降至正常(与对照组相比,P=0.304)。②术后第1、4、8、12周术腔愈合良好者分别占0、4.5%(1/22)、36.4%(8/22)、81.8%(18/22),鼻黏膜愈合情况与年龄、术前PDGF含量有关,年龄越小,PDGF含量越低,愈合越好。结论在鼻黏膜的创伤愈合过程中,PDGF、TNFα、HA具有不同的变化规律,年龄和术前PDGF含量是预测鼻黏膜愈合情况的参考指标。

Objective To detect the changing profiles of three factors in nasal fluid before and after endoscopic sinus surgery(ESS),including platelet derived growth factor(PDGF), tumour necrosis factor-α(TNF-α) and hyaluronic acid(HA), to investigate the predictive factor of healing quality after sinus surgery. Methods Nasal secretions were obtained from 22 patients with nasal polyp before ESS and at 1,4,8,12 weeks after ESS compared to 22 controls. Nasal fluid was analyzed by enzyme-linked immunosorbert assay(ELISA) for PDGF、TNF-α and HA. The healing quality was evaluated at 1,4,8,12 weeks postoperatively for every one. Finally, we performed a multiple logistic regression model to assess whether the healing quality was associated with age, gender, body mass, preoperative stage, and concentrations of PDGF、TNF-α、HA before ESS. Results ①Each factor before surgery showed different level when compared to controls,PDGF was constant, TNF-α was high(P=0.034),and HA was low(P=0.003). Comparing patients at 1 week after surgery with control subjects, a significant increase in the concentrations of PDGF、TNF-α、HA in nasal secretions could be demonstrated(compared to controls, P=0.000,0.020,0.038, respectively). After that, decreasing amounts of these factors were found, reaching normal conditions at 12 weeks for PDGF(compared to controls, P=0.087), 8 weeks for TNF-α(compared to controls, P=0.104),4 weeks for HA(compared to controls, P=0.304). There was another peak for TNF-α at 12 weeks (compared to controls, P=0.002).②The percentage of good healing at 1,4,8,12 week postoperatively was 0,4.5%,36.4%,81.8%,respectively.The healing quality after ESS was significantly and independently correlated to the age of patient and preoperative PDGF concentrations in nasal secretions. The younger, the better healing. The lower PDGF concentration, the better healing. Conclusions During the wound healing of nasal mucosa, the levels of PDGF、TNF-α、HA were different at each postoperative stage. Age and PDGF concentrations preoperatively were suitable factors to predict the healing quality after ESS.