Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Milan, Italy.
Can J Cardiol. 2012 May;28(3):311-7. doi: 10.1016/j.cjca.2011.11.005. Epub 2012 Jan 14.
The sympathetic nervous system is activated in a variety of cardiovascular and metabolic diseases. This is particularly the case for essential hypertension, in which various indices of adrenergic activity, such as plasma norepinephrine, norepinephrine spillover, and sympathetic nerve firing rate, are all well above the reference range of values, thereby documenting sympathetic overdrive. Evidence is available that sympathetic neural factors participate in disease progression, as well as in the development of cardiac and renal organ damage. These findings represent the rationale for therapeutic interventions that counteract the adrenergic overdrive in the hypertensive state. This paper, after reviewing the key findings of the neuroadrenergic abnormalities occurring in hypertension, examines the rationale and the technical details, as well as the results achieved so far, with the use of a new technique that allows the elimination of afferent and efferent innervation of the kidney in resistant hypertension, ie, the ablation of renal nerves. Strengths and potential limitations of the renal denervation approach are briefly addressed.
交感神经系统在多种心血管和代谢疾病中被激活。在原发性高血压中尤其如此，其中各种肾上腺素能活性指标，如血浆去甲肾上腺素、去甲肾上腺素溢出和交感神经放电率，都远高于参考值范围，从而证明存在交感神经驱动过度。有证据表明，交感神经因素参与疾病进展以及心脏和肾脏器官损伤的发生。这些发现为治疗干预提供了依据，以对抗高血压状态下的肾上腺素能驱动过度。本文在回顾高血压中发生的神经肾上腺素能异常的关键发现后，检查了使用一种新的技术消除抵抗性高血压中肾脏传入和传出神经支配（即肾脏神经消融）的原理、技术细节以及迄今为止取得的结果。简要讨论了肾脏去神经支配方法的优势和潜在局限性。
