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目的 探讨高压氧治疗对糖尿病患者足部溃疡的治疗作用以及氧化应激效果.方法 经患者知情同意,签署知情同意书,并经医院伦理委员会的同意,将36例WagnerⅠ～Ⅲ的糖尿病致足部溃疡患者随机分为高压氧组和对照组,前者除接受标准治疗外还接受高压氧治疗,对照组仅接受标准治疗.在第7天及第14天,对溃疡边缘的经皮氧压和溃疡面积减少百分比进行测量和计算,同时采集溃疡组织用来测定氧化应激的相关标示物,包括ELISA法测定丙二醛、Western-blot及逆转录聚合酶链式反应(reverse transcription-polymerase chain reaction,RT-PCR)检测抗氧化酶,如:超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化酶(GPx-1)蛋白和相关基因的表达水平.结果 高压氧组溃疡边缘的经皮氧压在第7天[(477.80±118.20) mm Hg]和第14天[(501.10±137.70) mm Hg]均较同期治疗前[分别为(37.06 ±5.23)、(35.61 ±4.85) mm Hg]明显升高(P＜0.01);与对照组[(18.1±6.5)％]比较,高压氧组溃疡面积直到第14天[(42.4±20.0)％]才明显减小;丙二醛含量、SOD、CAT蛋白和基因的表达水平高压氧组较对照组于治疗第14天均明显升高[丙二醛含量(92.6±18.8)比(29.0±4.3)nmol/g,SOD蛋白表达水平43.6±5.0比9.8±7.1,CAT蛋白表达水平27.6±10.1比3.1±1.7,SOD-1mRNA表达水平1.33 ±0.28比0.72±0.11,CAT mRNA表达水平2.18 ±0.46比1.27 ±0.26] (P ＜0.05);GPx-1在第7天和第14天均未见明显差异.结论 糖尿病致足部溃疡的患者,持续14 d的高压氧治疗是一个有效的辅助手段,但是随着高压氧治疗时间延长也会在局部溃疡组织内引起氧化应激反应.“,”Objective To evaluate the therapeutic effect of hyperbaric oxygen (HBO) on chronic diabetic foot ulcer and its oxidative stress effect.Methods With the knowledge and consent of the patients and following the signing of the letter of agreement,36 patients with WagnerⅠ-Ⅲ diabetic foot ulcer were randomly divided into the HBO group and the control group.The HBO group received HBO therapy in addition to routine treatment,while the control group was just administered with routine treatment.Transcutaneous oxygen pressure (TcPO2) at the edge of the ulcer and the decrease in percentage of ulcer size were measured on day 7 and day 14.At the same time,ulcer tissues were harvested to determine related marker associated with oxidative stress,including the level of Malondialdehyde (MDA) measured with ELISA,and the expression levels of proteins and related genes of antioxidant enzymes,such as superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GPx-1) with Western-blot and RT-PCR.Results TcPO2 levels at the edge of the ulcer following HBO therapy increased significantly on day 7 [(477.80 ± 118.20) mm Hg] and day 14 [(501.10 ± 137.70) mm Hg],when they were compared with those before treatment (P ＜ 0.01).Before treatment,TcPo2 levels were (37.06 ±5.23) mm Hg and (35.61 ± 4.85) mm Hg respectively (P ＜ 0.01).However,when it was compared with the control group[(18.1 ± 6.5)％],the percentage of ulcer size for the HBO group failed to reduce considerably until on the 14th day [(42.4 ± 20.0) ％].At the same time,the expression levels of MDA,SOD and CAT all increased.MDA was [(92.6 ± 18.8)∶(29.0 ± 4.3) nmol/g],the level of protein SOD was [(43.6 ± 5.0) ∶ (9.8 ± 7.1)] and CAT was [(27.6 ± 10.1) ∶ (3.1 ± 1.7)],the level of related gene of antioxidant onzyme SOD-1 was [(1.33 ± 0.28) ∶ (0.72 ± 0.11)] and CAT was [(2.18 ± 0.46) ∶ (1.27 ± 0.26)] (P ＜ 0.05).However,on day 7 and day 14,no abnormality was detected in GPx-1.Conclusions Our research indicated that HBO therapy for successive 14 days was an effective accessory treatment method for patients with chronic diabetic foot ulcer.However,in prolonged treatment,HBO therapy could induce oxidative stress in the local ulcer tissue.For this reason,it might be better for those patients to avoid prolonged and inappropriate HBO therapy.