经皮肾脏交感神经射频消融术对顽固性高血压患者肾素血管紧张系统的影响  

The effect of catheter based renal symthetic denervation on renin-angiotensin-aldosterone system in patients with resistant hypertension

作　　者：王丽[1] 卢成志[2] 张欣[3] 罗迪[1] 赵斌[1] 于翔[2] 夏大胜[2] 陈欣[2] 赵向东[2] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院心内科 [3]天津市第一中心医院检验科

出　　处：《中华心血管病杂志》2013年第1期3-7,共5页Chinese Journal of Cardiology

基　　金：天津市卫生局攻关项目（10KG218）

摘　　要：目的观察经皮肾交感神经射频消融对顽固性高血压患者肾素．血管紧张素-醛固酮系统（RAAS）的影响及降压效果，并对肾交感神经射频消融的安全性及有效性进行分析。方法连续入选自2011年6月至12月在我科住院治疗的顽固性高血压病患者10例，行经皮肾交感神经射频消融术，观察术前及术后1周、1、3和6个月的血压变化及肾素、血管紧张素Ⅱ、醛固酮、肌酐、尿常规、心率等指标，评价手术的有效性与安全性并探讨其机制。结果经皮肾交感神经消融术后1周、1、3和6个月患者的平均血压分别下降了22．8／9．1mmHg（1mmHg=0．133kPa）、34．8／14．7mmHg、42．6／20．7mmHg和43．2／21．6mmHg（P〈0．001），与此同时，患者术后的肾素、血管紧张素Ⅱ、醛固酮水平也分别下降了（1．11±0．89）ng·ml^-1·h^-1（P=0．003）、（17．06±13．82）ng／L（P=0．004）、（404．5±285．8）ng/L（P=0．002）；术后2周心率下降了5．10次／min（P=0．002），并且肌酐、估算肾小球滤过率水平无明显变化（P〉0．05）。结论经皮肾交感神经射频消融术能够降低肾素、血管紧张素Ⅱ、醛固酮水平，并且对血压产生显著和持久的下降。Objective to explore the effect of catheter based renal symthetic denervation on reninangiotensin-aldosterone system（RAAS） and blood pressure reduction in patients with resistant hypertension. and assess the validity and security of the treatment. Methods Ten patients with resistant hypertension from June 2011 to December 2011 were retrospectively reviewed, and then all of 10 patients screened for eligibility were allocated to renal denervation. Primary endpoints were changes of office blood pressure at 1 week, 1,3 and 6 months after procedure. We assessed the effectiveness of renal sympathetic denervation with heart rate （ HR）, renin activity （ PRA）, angiotensin Ⅱ （ Ang Ⅱ ）, aldosterone（ Ald）, and creatinine（Cr） before and 2 weeks after procedure. Results Office blood pressure after catheter-based renal denervation decreased by 22. 8/9. 1 mm Hg（1 mm Hg =0. 133 kPa）, 34. 8/14. 7 mm Hg, 42. 6/20. 7 mm Hg,43.2/ 21.6 mm Hg, at 1 week, 1,3 and 6 months, respectively （ P 〈 0. 001 ）. Meanwhile, the level of PRA, Ang Ⅱ, Ald decreased by （1.11±0.89）ng·ml^-1·h^-1（P=0.003）、（17.06±13.82）ng/L（P=0.004）、（404.5±285.8）ng/L（P=0.002）, respectively; and heart rate decreased by 5.1 bpm （ P = 0. 002 ）. However, the Cr level and eGFR did not change significantly （ P 〉 0. 05 ）. Conclusion Catheter-based renal sympathetic denervation can reduce the level of renin activity, angiotensin Ⅱ and aldosterone, and causes substantial and sustained blood-pressure reduction.

关 键 词：高血压 导管消融术 肾素-血管紧张素系统 

分 类 号：R544.1[医药卫生—心血管疾病]