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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 investigate the changes of nasal secretion of platelet derived growth factor (PDGF), tumor necrosis factor α (TNFα) and hyaluronic acid (HA) before and after endoscopic sinus surgery and to study the prediction of nasal mucosal healing factor. Methods Enzyme linked immunosorbent assay (ELISA) was performed on 22 patients with nasal polyps of nasal polyps treated with endoscopic sinus surgery. The levels of PDGF, TNFα, HA in nasal secretion at 1, 4, 8 and 12 weeks after operation The contents of three factors in nasal secretion of 22 healthy volunteers were measured as the control group. The healing status of the cavities at 1, 4, 8 and 12 weeks postoperatively was observed and compared with the gender, age, body weight, Logistic regression analysis was performed between the three types of factors and the preoperative staging. Results ① The contents of three factors in preoperative nasal secretion of rhinosinusitis and nasal polyps were: PDGF in the normal range, TNFα higher than the control group (P = 0.034), HA significantly lower than the control group (P = 0.003). The levels of three factors increased postoperatively and peaked at the first week (P values of PDGF, TNFα and HA were 0.000,0.020 and 0.038, respectively, compared with the control group), and then decreased gradually. PDGF decreased at the twelfth week To normal (P = 0.087 vs. control), TNFα decreased to normal at week 8 (P = 0.104 vs. control, P12.00) and increased again at 12 weeks ), HA decreased to normal in the 4th week (P = 0.304 compared with the control group). ② The healing of the mucosa at the 1st, 4th, 8th and 12th week after operation were 0, 4.5% (1/22), 36.4% (8/22), 81.8% (18/22) Age, preoperative PDGF content, the younger, the lower the PDGF content, the better the healing. Conclusions In the process of wound healing of nasal mucosa, PDGF, TNFα and HA have different changing rules, and the age and preoperative PDGF content are the reference indexes for predicting nasal mucosa healing.