Hiperbarik Oksijen Tedavisinin, Diyabetik Ayak Yarası Olan Hastalarda Hipoksiyle İndüklenen Faktör-1α, İndüklenebilir Nitrik Oksit Sentaz ve Vasküler Endotelyal Büyüme Faktörü Seviyeleri Üzerine Etkisi

Hiperbarik oksijen tedavisinin (HBOT) hipoksik yara ortamını düzelterek yara iyileşmesine katkıda bulunduğu birçok çalışmayla kanıtlanmıştır. Ancak yara bölgesinde arttırılan oksijenin hangi mekanizmalarla yara iyileşmesine katkıda bulunduğu halen aydınlatılmaya çalışılan bir konudur. Bu çalışma diyabetik ayak iyileşmesinde etkisi olduğunu düşündüğümüz hipoksiyle indüklenen faktör-1α (HIF-1α), indüklenebilir nitrik oksit sentaz (iNOS) ve vasküler endotelyal büyüme faktörü (VEGF) seviyeleri üzerine HBOT’ nin etkilerini araştırmayı amaçlamıştır. Çalışmaya Wagner sınıflaması evre 2-3 ve 4 diyabetik ayak yarası olan 20 hasta dahil edilmiştir. Hastaların yaralarından küretajla ilk HBOT seansı öncesi ve 10. seans sonrası doku örnekleri alınmış ve -82 °C’ de saklanmıştır. Tüm örnekler toplandıktan sonra, bahsedilen parametrelerin ekspresyonları polimeraz zincir reaksiyonu çalışmasıyla değerlendirilmiştir. Sonuçlar HIF1-α’ daki artışın, iNOS ve VEGF’ deki artışla anlamlı korelasyonu olduğunu göstermiştir (p<0.05). Majör ve minor amputasyona giden hastalarda VEGF, iNOS ve HIF1-α seviyeleri artarken iyileşen hastalarda tüm parametreler düşüş göstermiştir, ki bu farklar istatistiksel olarak anlamsız bulunmuştur. Bu verilere göre HBOT’ nin uzamış hipoksik stimulusu inhibe ettiği ve bahsedilen parametrelerin seviyeleri ile bunların uzamış ve yoğun ekspresyonlarının yara iyileşmesi üzerindeki olumsuz etkilerini azalttığı sonucuna vardık.

Anahtar Kelimeler:

Diyabetik Ayak, Hiperbarik Oksijen, Hipoksiyle İndüklenen Faktör, Yara İyileşmesi

The Effects of Hyperbaric Oxygen Treatment on Hypoxia Inducible Factor-1α, Inducible Nitric Oxide Synthase and Vascular Endothelial Growth Factor Levels in Patients with Diabetic Foot Wound

A number of studies have proved that hyperbaric oxygen therapy (HBOT) contributes to wound healing by improving hypoxic wound site. However, the mechanisms, by which the enhanced oxygen in the wound site contributes to wound healing, still remain to be elucidated. This study aimed to investigate the effects of the HBOT on hypoxia inducible factor-1α (HIF-1α), inducible nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF) levels that we consider influential on diabetic foot healing. 20 patients were included in the study with diabetic foot wounds of Wagner classification grade 2-3 and 4. Tissue samples from the patients’ wounds were taken before the first HBOT session and after the 10th session by curettage and stored at -82 °C. Upon collection of all samples, expressions of the stated parameters were examined through polymerase chain reaction (PCR) study. The results revealed that the increase in HIF1-α has a meaningful correlation with the increase in iNOS and VEGF (p<0.05). VEGF, iNOS and HIF1-α levels in patients who underwent major or minor amputations went up; while all parameters in patients who recovered indicated decline which is statistically non-significant. According to these data, we concluded that HBOT inhibited prolonged hypoxic stimulus and decreased both the levels of the mentioned parameters and the negative effects of prolonged and intense expressions of them on wound healing.

Keywords:

Diabetic Foot, Hyperbaric Oxygen, Hypoxia Inducible Factor, Wound Healing,

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