自主神经系统功能障碍是否会影响肾去神经支配术在降低血压方面的成功率？
Does dysfunction of the autonomic nervous system affect success of renal denervation in reducing blood pressure?
作者信息
Fricke Lisa, Petroff David, Desch Steffen, Lurz Philipp, Reinhardt Sebastian, Sonnabend Melanie, Classen Joseph, Baum Petra
机构信息
Department of Neurology, University Hospital Leipzig, Leipzig, Germany.
Clinical Trial Centre, Leipzig University, Leipzig, Germany.
出版信息
SAGE Open Med. 2017 Apr 27;5:2050312117702031. doi: 10.1177/2050312117702031. eCollection 2017.
OBJECTIVES
Renal denervation is an interventional approach aiming to reduce high blood pressure. Its efficacy is subject of controversial debate. We analyzed autonomic function in patients undergoing renal denervation to identify responders.
METHODS
A total of 21 patients with treatment-resistant hypertension scheduled for renal denervation were included. Heart rate variability, pupillary function and sympathetic skin response were examined prior to intervention. Before and 1 or 3 months after intervention, 24-h ambulatory blood pressure readings were taken.
RESULTS
Patients were stratified according to sympathetic nervous system function. Sympathetic activity was reduced in 12 participants (group 1) and normal or enhanced in nine patients (group 2). The mean of daytime systolic blood pressure decreased in groups 1 and 2 from 168 to 157 mmHg (95% confidence interval for difference, 1-21 mmHg, p = 0.035) and from 166 to 145 mmHg (8-34 mmHg, p = 0.005), respectively. In a linear model, blood pressure reduction was 11.3 mmHg (0.3-22 mmHg) greater in group 2 than in group 1 (p = 0.045).
CONCLUSION
Patients with preexisting reduced activity of the sympathetic nervous system benefited less from renal denervation.
目的
肾去神经支配是一种旨在降低高血压的介入方法。其疗效存在争议。我们分析了接受肾去神经支配患者的自主神经功能，以识别反应者。
方法
共纳入21例计划接受肾去神经支配的顽固性高血压患者。在干预前检查心率变异性、瞳孔功能和交感皮肤反应。在干预前以及干预后1个月或3个月，进行24小时动态血压读数。
结果
根据交感神经系统功能对患者进行分层。12名参与者（第1组）的交感神经活动降低，9名患者（第2组）的交感神经活动正常或增强。第1组和第2组白天收缩压均值分别从168 mmHg降至157 mmHg（差值的95%置信区间为1 - 21 mmHg，p = 0.035）和从166 mmHg降至145 mmHg（8 - 34 mmHg，p = 0.005）。在线性模型中，第2组的血压降低幅度比第1组大11.3 mmHg（0.3 - 22 mmHg）（p = 0.045）。
结论
交感神经系统活动预先降低的患者从肾去神经支配中获益较少。
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