肾去神经后血管和肾脏血流动力学的变化。
Vascular and renal hemodynamic changes after renal denervation.
机构信息
Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
出版信息
Clin J Am Soc Nephrol. 2013 Jul;8(7):1195-201. doi: 10.2215/CJN.08500812. Epub 2013 Apr 4.
BACKGROUND AND OBJECTIVES
Renal denervation (RDN) has been shown to be effective in reducing BP in treatment-resistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Nineteen patients with treatment-resistant hypertension (office BP≥140/90 mmHg, despite at least three antihypertensive drugs [including a diuretic], and diagnosis confirmed by 24-hour ambulatory BP monitoring) underwent RDN between January and October 2011. Renal perfusion and RVR were noninvasively assessed by magnetic resonance imaging with arterial spin labeling, and renal function was assessed by estimating GFR before (day -1), after (day +1), and again after 3 months of RDN. Central hemodynamics was assessed using pulse wave analysis at day -1 and after 6 months of RDN.
RESULTS
Peripheral office BP (systolic, 158±26 versus 142±23 mmHg, P=0.002; diastolic, 83±13 versus 76±9 mmHg, P=0.02) and mean systolic 24-hour ambulatory BP (159±17 versus 152±17 mmHg, P=0.02) were significantly reduced 6 months after RDN. Renal perfusion was not statistically different between day -1 and day +1 (256.8 [interquartile range (IQR), 241-278] versus 263.4 [IQR, 252-277] ml/min per 100 g; P=0.17) as well as after 3 months (256.8 [IQR, 241-278] versus 261.2 [IQR, 240-285] ml/min per 100 g; P=0.27) after RDN. RVR dropped (432.1 [IQR, 359-525] versus 390.6 [IQR, 338-461] AU; P=0.02), whereas renal function was not statistically different at any time point. Central systolic BP (145±31 versus 131±28 mmHg; P=0.009), diastolic BP (85±18 versus 80±14 mmHg; P=0.03), and central pulse pressure (61±18 versus 52±18 mmHg; P=0.02) were significantly reduced 6 months after RDN. Central augmentation index (24±8 versus 20±8%; P=0.02) was decreased 6 months after RDN.
CONCLUSION
The data indicate that RDN significantly reduced peripheral and central BP. Despite reduced systemic BP, renal perfusion and function did not change after RDN.
背景和目的
肾去神经术（RDN）已被证明可有效降低治疗抵抗性高血压患者的血压。对肾脏和交感神经活性的测量显示，RDN 后肾脏和小阻力血管的交感神经驱动下降。然而，关于肾灌注和肾血管阻力（RVR）以及中心血液动力学的后果尚不清楚。
设计、设置、参与者和测量：19 例治疗抵抗性高血压患者（诊室血压≥140/90mmHg，尽管使用了至少三种降压药物[包括利尿剂]，并通过 24 小时动态血压监测确认诊断）于 2011 年 1 月至 10 月期间接受 RDN。通过动脉自旋标记的磁共振成像无创评估肾灌注和 RVR，并在 RDN 前（第-1 天）、后（第+1 天）和 3 个月后评估估计肾小球滤过率（GFR）。在第-1 天和 RDN 后 6 个月使用脉搏波分析评估中心血液动力学。
结果
外周诊室血压（收缩压，158±26 与 142±23mmHg，P=0.002；舒张压，83±13 与 76±9mmHg，P=0.02）和平均 24 小时动态血压（159±17 与 152±17mmHg，P=0.02）在 RDN 后 6 个月显著降低。RDN 前后第-1 天（256.8[四分位距（IQR），241-278]与 263.4[IQR，252-277]ml/min/100g；P=0.17）和 3 个月后（256.8[IQR，241-278]与 261.2[IQR，240-285]ml/min/100g；P=0.27）的肾灌注无统计学差异。RVR 下降（432.1[IQR，359-525]与 390.6[IQR，338-461]AU；P=0.02），而肾功能在任何时间点均无统计学差异。RDN 后 6 个月，中心收缩压（145±31 与 131±28mmHg；P=0.009）、舒张压（85±18 与 80±14mmHg；P=0.03）和中心脉压（61±18 与 52±18mmHg；P=0.02）均显著降低。RDN 后 6 个月，中心增强指数（24±8 与 20±8%；P=0.02）降低。
结论
数据表明，RDN 可显著降低外周和中心血压。尽管全身血压降低，但 RDN 后肾灌注和功能未发生变化。
Zotero 插件