Abstract

Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by localized inflammation of the upper respiratory tract. One of the methods of treatment of CRS is endonasal maxillotomy. However, the regeneration of tissues damaged during surgery remains an important issue, so the determination of markers of the inflammatory response – biochemical indicators of antioxidant and regenerative activity – is extremely important. The activity of the alteration process and the degree of postoperative damage is characterized by the concentration of glycosaminoglycans and free L-oxyproline, the state of the oxidative stress system and antioxidant defense – the content of nitrite and sulfide anion.

Aim: determination of the content of markers of antioxidant and regenerative activity in nasal mucosa ash in patients with chronic rhinosinusitis.

Materials and methods: The main group consisted of 47 patients with chronic rhinosinusitis who received standard treatment and topical N-acetylcysteine up to 10 days after surgery. The control group consisted of 49 patients who received standard treatment and 0.9% sodium chloride solution. Biochemical parameters in the nasal mucosa ash (L-oxyproline, glycosaminoglycans, nitrites and sulfide anions) were determined before treatment, on days 3, 10 and 28 after endonasal maxillotomy and for better access to the sinus for additional septoplasty. The results were statistically analyzed using Student’s t-test for two independent samples, Mann-Whitney U-test, and Wilcoxon test. Differences were considered significant at p<0.05.

Results: An increase in the concentration of nitrite on day 3 of the experiment was detected, which is a direct consequence of the high activity of iNOS during this period of the experiment. The absence of statistically significant changes in the concentration of nitrite on day 28 indicates the effective utilization of excess nitric oxide and the enhancement of antibacterial protection of the mucous membrane due to the high activity of iNOS in the long term of treatment.

There was to increase the concentration of GAG on days 3, 10 and 28 of the study in the experimental group compared to the control group and to decrease relative to the groups on the first day after surgery. The decrease in the concentration of free L-oxyproline in the experimental group on days 3, 10, 28 relatives to the first day of the postoperative period indicates the predominance of collagen breakdown over its synthesis, which prevents the development of fibrosis. The development of more intense oxidative stress was evidenced by an increased concentration of sulfide anion in patients of the control group from day 3 to day 10.

Conclusions: the use of topical N-acetylcysteine in combination with complex therapy in the postoperative period for the treatment of CRS normalizes antioxidant and regenerative activity, which in turn leads to improved tissue healing and reduced recovery time.

Key words: chronic rhinosinusitis, nasal mucosa, maxillotomy, oxidative stress, iNOS, L-oxyproline, N-acetylcysteine.