Department of Physical Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran; Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Diabetes Res Clin Pract. 2017 May;127:147-155. doi: 10.1016/j.diabres.2017.03.012. Epub 2017 Mar 21.
This study investigated the effect of low-intensity cathodal direct current (CDC) of electrical stimulation (ES) on the release of hypoxic inducible factor-1α (HIF-1α), nitric oxide (NO), vascular endothelial growth factor (VEGF), and soluble VEGF receptor-2 (sVEGFR-2) in the wound fluid of ischemic diabetic foot ulcers (DFUs).
This study was a randomized, single-blind, placebo-controlled trial. Thirty type 2 diabetes patients with ischemic foot ulcerations were randomly assigned to receive either low-intensity CDC at sensory threshold (ES group, n=15) or placebo treatment (control group, n=15) for 1h/day, 3days/week, for 4weeks (12 sessions). After debridement during the first and twelfth treatment sessions, wound fluid was collected before and after ES application to determine the levels of HIF-1α, NO, VEGF, and sVEGFR-2. Wound surface area (WSA) was measured at the first, sixth, and twelfth sessions.
At the first session, after ES application, wound-fluid levels of HIF-1α were significantly increased (+61.98pg/mL) compared to the control group (-3.85pg/mL, P=0.01). After ES application at the first and twelfth sessions, wound-fluid levels of VEGF were also significantly increased (+36.77 and +39.57pg/mL, respectively) compared to the control group (+4.15 and +0.15pg/mL, P=0.007 and P=0.019, respectively). There was no significant effect on NO and sVEGFR-2 levels between the groups.
Low-intensity CDC has positive effects on the release of HIF-1α and VEGF in the wound area of ischemic DFUs. Furthermore, our results suggest that applying ES to ischemic DFUs can be a promising way to promote angiogenesis and to achieve better outcomes in diabetic wound healing.
本研究旨在探讨低强度阴极直流电刺激（CDC）对缺血性糖尿病足溃疡（DFU）创面液中缺氧诱导因子-1α（HIF-1α）、一氧化氮（NO）、血管内皮生长因子（VEGF）和可溶性血管内皮生长因子受体-2（sVEGFR-2）释放的影响。
这是一项随机、单盲、安慰剂对照试验。将 30 名 2 型糖尿病合并缺血性足部溃疡患者随机分为接受低强度 CDC （ES 组，n=15）或安慰剂治疗（对照组，n=15），每天 1 小时，每周 3 天，共 4 周（12 次）。在第一次和第十二次治疗时进行清创，在 ES 应用前后采集创面液，以测定 HIF-1α、NO、VEGF 和 sVEGFR-2 的水平。在第一次、第六次和第十二次治疗时测量创面面积（WSA）。
在第一次治疗时，ES 治疗后创面液中的 HIF-1α 水平显著升高（+61.98pg/mL），而对照组（-3.85pg/mL，P=0.01）。与对照组相比，ES 治疗第一次和第十二次时，创面液中的 VEGF 水平也明显升高（分别增加+36.77 和+39.57pg/mL，P=0.007 和 P=0.019）。两组间 NO 和 sVEGFR-2 水平无显著差异。
低强度 CDC 对缺血性 DFU 创面 HIF-1α 和 VEGF 的释放有积极作用。此外，我们的结果表明，将 ES 应用于缺血性 DFU 可能是一种促进血管生成的有前途的方法，可实现糖尿病创面愈合的更好结果。
