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-alpha (TNF-alpha) 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 immunosorbent assay (ELISA) for PDGF, TNF-alpha 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-alpha, HA before ESS.
Results: 1. Each factor before surgery showed different level when compared to controls, PDGF was constant, TNF-alpha 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-alpha, 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-alpha (compared to controls, P =0.104), 4 weeks for HA (compared to controls, P = 0.304). There was another peak for TNF-alpha at 12 weeks (compared to controls, P = 0.002). 2. The 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-alpha, HA were different at each postoperative stage. Age and PDGF concentrations preoperatively were suitable factors to predict the healing quality after ESS.