Hedetoft Morten, Olsen Niels V, Smidt-Nielsen Isabel G, Wahl Anna M, Bergström Anita, Juul Anders, Hyldegaard Ole
The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Corresponding author: Dr Morten Hedetoft, The Hyperbaric Oxygen Treatment Unit, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark,
Diving Hyperb Med. 2020 Mar 31;50(1):17-23. doi: 10.28920/dhm50.1.17-23.
Treatment of diabetic foot ulcers is complex and often protracted. Hyperbaric oxygen treatment (HBOT) improves wound healing in diabetic ulcers and serves as an important adjunct to regular diabetic wound care. Endothelial dysfunction plays a central role in diabetes-related vascular complications and may be evaluated by a non-invasive technique called peripheral arterial tonometry which measures a reactive hyperaemia index (RHI). We hypothesized that endothelial function measured by peripheral arterial tonometry is impaired in diabetic foot ulcer patients and that HBOT might improve endothelial function.
Endothelial function was prospectively assessed by peripheral arterial tonometry in 22 subjects with diabetic foot ulcers and 17 subjects without diabetes during courses of HBOT. Endothelial function was evaluated before first (baseline) and 30th treatments, and at 90-day follow-up. Serum insulin growth factor-I (IGF-I) concentrations were determined by immunoassay. Results were compared to 23 healthy subjects.
No baseline differences were found in endothelial function between subjects with diabetes, HBOT patients without-diabetes and healthy control subjects (RHI; 1.26, 1.61 and 1.81, respectively). No significant changes in RHI were found in patients with (P = 0.17) or without (P = 0.30) diabetes during courses of HBOT. At 90-day follow-up IGF-I was significantly reduced in the subjects with diabetes (P = 0.001) and unchanged in the group without diabetes (P = 0.99).
We found no significant differences in RHI between subjects with diabetic foot ulcers and patients without diabetes, nor improvement in endothelial function assessed by peripheral arterial tonometry during courses of HBOT.
糖尿病足溃疡的治疗复杂且往往迁延不愈。高压氧治疗（HBOT）可促进糖尿病溃疡的伤口愈合，是常规糖尿病伤口护理的重要辅助手段。内皮功能障碍在糖尿病相关血管并发症中起核心作用，可通过一种名为外周动脉张力测量法的非侵入性技术进行评估，该技术可测量反应性充血指数（RHI）。我们推测，糖尿病足溃疡患者通过外周动脉张力测量法测得的内皮功能受损，而HBOT可能改善内皮功能。
在HBOT疗程中，对22例糖尿病足溃疡患者和17例非糖尿病患者进行外周动脉张力测量法前瞻性评估内皮功能。在首次治疗前（基线）、第30次治疗时以及90天随访时评估内皮功能。通过免疫测定法测定血清胰岛素生长因子-I（IGF-I）浓度。将结果与23例健康受试者进行比较。
糖尿病患者、接受HBOT治疗的非糖尿病患者和健康对照受试者之间在内皮功能方面未发现基线差异（RHI分别为1.26、1.61和1.81）。在接受HBOT治疗的糖尿病患者（P = 0.17）或非糖尿病患者（P = 0.30）中，RHI未发现显著变化。在90天随访时，糖尿病患者的IGF-I显著降低（P = 0.001），非糖尿病组无变化（P = 0.99）。
我们发现糖尿病足溃疡患者与非糖尿病患者在RHI方面无显著差异，在HBOT疗程中通过外周动脉张力测量法评估的内皮功能也未改善。
