高压氧治疗对糖尿病足患者胶原合成和氮氧化合物的影响

Effect of hyperbaric oxygen therapy on collagen synthesis and nitric oxide in diabetic foot patients

目的探讨高压氧治疗对糖尿病足患者胶原合成和氮氧化合物(NOx)的影响。方法纳入20例糖尿病足慢性溃疡患者,所有患者接受常规治疗,胰岛素控制血糖和抗生素控制感染。在此基础上,给予患者吸入100%的纯氧,压力为2.4个大气压,持续105min,1周5次,连续治疗6周,共30次。检测治疗前后患者血糖、糖化血红蛋白(HbA1C)、C反应蛋白(CRP)及创面面积。此外检测血浆Ⅰ型前胶原肽(PⅠNP)和Ⅲ型前胶原肽(PⅢNP)及NOx。结果治疗后,所有患者血糖和HbA1c水平降低(P<0.001),CRP水平在治疗后下降(P<0.001)。接受高压氧治疗后20名患者血浆PⅠNP和PⅢNP水平升高,差异有统计学意义(P<0.01),NOx治疗前后的水平比较差异无统计学意义(P>0.05)。创面愈合程度大于50%的患者治疗后NOx的水平明显升高(P<0.05),创面愈合程度小于50%的患者治疗后NOx的水平明显降低(P<0.05)。结论高压氧治疗可以增加糖尿病足(DF)患者血浆PⅠNP和PⅢNP的水平,适宜浓度的NOx可以促进创面的愈合。

Objective To explore the effect of hyperbaric oxygen therapy on collagen synthesis and nitric oxide in diabetic foot patients.Methods Twenty patients with diabetic foot ulcerations were included.All patients were received routine therapy,blood glucose and infection were controlled by insulin and antibiotics.On that basis,all patients were given 100% oxygen at 2.4 absolute atmosphere for about 105 min,five times a week for a total of 30 sessions.Blood glucose,hemoglobin A1c,C-reactive protein and wound area were measured before and after hyperbaric oxygen treatment.Blood plasma procollagen type Ⅰ and Ⅲ N-terminal peptides and total nitrite/nitrate（NOx） levels were also determined.Results After hyperbaric oxygen therapy,blood glucose,hemoglobin A1c and C-reactive protein were decreased（P0.001）.Both PⅠNP and PⅢNP were significantly increased（P0.01）.However,the level of NOx were not increased（P0.05）.NOx level was increased in the patients with wounds surface healing more than 50% or higher（P0.05）,while NOx level was decreased in the patients with wounds surface healing less than 50%（P0.05）.Conclusion After hyperbaric oxygen therapy,the plasma PⅠNP and PⅢNP levels are increased in diabetic foot patients,there is an optimum NOx levels for its contribution to the healing process.