Wei Shujie, Li Dan, Zhang Yan, Su Linan, Zhang Yunrong, Wang Qiang, Yang Dachun, Li De, Yang Yongjian, Ma Shuangtao
Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China.
Department of Internal Medicine, Shapingba People's Hospital, Chongqing, China.
PLoS One. 2017 Apr 28;12(4):e0176888. doi: 10.1371/journal.pone.0176888. eCollection 2017.
Catheter-based renal denervation (RDN) is a promising approach to treat hypertension, but innervation patterns limit the response to endovascular RDN and the post-procedural renal artery narrowing or stenosis questions the endovascular ablation strategy. This study was performed to investigate the anti-hypertensive and target organ protective effects of perivascular RDN in spontaneously hypertensive rats (SHR).
SHR and normotensive Wistar-Kyoto (WKY) rats were divided into sham group (n = 10), radiofrequency ablation group (n = 20) in which rats received bilateral perivascular ablation with radiofrequency energy (2 watts), and chemical (10% phenol in 95% ethanol) ablation group (n = 12). The tail-cuff blood pressure was measured before the ablation and on day 14 and day 28 after the procedure. The plasma levels of creatinine, urea nitrogen, and catecholamines, urinary excretion of electrolytes and protein, and myocardial and glomerular fibrosis were analyzed and compared among the groups on day 28 after the procedure.
We identified that 2-watt is the optimal radiofrequency power for perivascular RDN in rats. Perivascular radiofrequency and chemical ablation achieved roughly comparable blood pressure reduction in SHR but not in WKY on day 14 and day 28 following the procedure. Radiofrequency-mediated ablation substantially destroyed the renal nerves surrounding the renal arteries of both SHR and WKY without damaging the renal arteries and diminished the expression of tyrosine hydroxylase, the enzyme marker for postganglionic sympathetic nerves. Additionally, perivascular radiofrequency ablation also decreased the plasma catecholamines of SHR. Interestingly, both radiofrequency and chemical ablation decreased the myocardial and glomerular fibrosis of SHR, while neither increased the plasma creatinine and blood urea nitrogen nor affected the urinary excretion of electrolytes and protein when compared to sham group.
Radiofrequency-mediated perivascular RDN may become a feasible procedure against hypertension, and provide similar anti-hypertensive and target organ protective effects as does the chemical ablation.
基于导管的肾去神经支配术（RDN）是一种治疗高血压的有前景的方法，但神经分布模式限制了对血管内RDN的反应，且术后肾动脉狭窄问题对血管内消融策略提出了质疑。本研究旨在探讨血管周围RDN对自发性高血压大鼠（SHR）的降压及靶器官保护作用。
将SHR和正常血压的Wistar-Kyoto（WKY）大鼠分为假手术组（n = 10）、射频消融组（n = 20，大鼠接受双侧血管周围2瓦射频能量消融）和化学（95%乙醇中10%苯酚）消融组（n = 12）。在消融前及术后第14天和第28天测量尾套血压。在术后第28天分析并比较各组的血浆肌酐、尿素氮和儿茶酚胺水平、电解质和蛋白质的尿排泄量以及心肌和肾小球纤维化情况。
我们确定2瓦是大鼠血管周围RDN的最佳射频功率。在术后第14天和第28天，血管周围射频和化学消融在SHR中实现了大致相当的血压降低，但在WKY中未实现。射频介导的消融显著破坏了SHR和WKY肾动脉周围的肾神经，而未损伤肾动脉，并减少了节后交感神经的酶标志物酪氨酸羟化酶的表达。此外，血管周围射频消融还降低了SHR的血浆儿茶酚胺水平。有趣的是，与假手术组相比，射频和化学消融均降低了SHR的心肌和肾小球纤维化，且均未增加血浆肌酐和血尿素氮，也未影响电解质和蛋白质的尿排泄。
射频介导的血管周围RDN可能成为一种治疗高血压的可行方法，并提供与化学消融相似的降压及靶器官保护作用。
