背景:体外震波作为一种非侵入性的物理刺激近年来发现具有促进新生血管形成、促进组织修复的功能.目的:观察体外震波对创面内血管内皮细胞生长因子表达和新血管形成的影响及促进创面愈合的作用.方法:72 只SD 大鼠随机均分为治疗组、糖尿病组及对照组.治疗组和糖尿病组制作糖尿病慢性创面模型.建模后1 d 治疗组创面用体外震波处理,糖尿病组和对照组仅涂抹耦合液.观察创面的肉芽组织和新血管形成情况,检测血管内皮细胞生长因子蛋白含量及mRNA 的表达水平.结果与结论:与糖尿病组比较,治疗组创面的闭合率增加.治疗后3 d 开始,治疗组创面内毛细血管数量比糖尿病组增多,肉芽组织相应增加.与对照组比较,糖尿病组血管内皮细胞生长因子蛋白含量和mRNA 表达水平在3 d 和7 d 均降低,在7 d 出现下降.经体外震波治疗后,各时间段表达均增高,在14 d 出现下降.说明糖尿病创面局部血管内皮细胞生长因子分泌量降低和高表达时段缩短是其难愈的重要因素之一,体外震波治疗可增加糖尿病创面组织内血管内皮细胞生长因子的表达强度,延长其高表达的时间,从而促进创面内新血管形成,最终加快肉芽组织生长和创面愈合.%BACKGROUND: Extracorporeal shock wave (ESW) as a non-invasive physical stimulation can promote angiogenesis and tissue repair. OBJECTIVE: To observe the effect of low-energy ESW on vascular endothelial growth factor (VEGF) expression and its role in promoting diabetic wound healing. METHODS: Totally 72 Sprague Dawley rats were randomly divided into treatment, diabetes and control groups. Diabetic chronic wound models were established in the treatment and diabetes groups. The ESW was used for the treatment group at 1 day after modeling, but coupling liquid was used for the diabetes and control groups. Granulation tissue of the wound and formation of new blood vessels were observed. Protein content of VEGF and expression of mRNA were detected. RESULTS AND CONCLUSION: Compared with the diabetes group, closure rate of the wound in the treatment group was increased. The number of microvessels within the wound was increased in the treatment group at 3 days after treatment than in the diabetes group, and corresponding granulation tissues were increased simultaneously. Compared with the control group, expressions of VEGF protein and mRNA were lower in the diabetic control group at 3 and 7 days after treatment, moreover, declined at 7 days after treatment. After the ESW treatment, the protein content of VEGF and expression of mRNA level were increased at 3, 7, 14 and 21 days after treatment and began to decline at 14 days after treatment. This suggested that the reduced expression level of VEGF and decreased period of its expression can contribute to the impaired healing of diabetic wound. The ESW treatment can increase the expression of VEGF and extend the time of its high expression to promote wound angiogenesis and ultimately accelerate the growth of granulation tissue and diabetic wound healing.
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