Kiuchi M G, Chen S, Rodrigues Paz L M, Pürerfellner H
Division of Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil; Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
Hipertens Riesgo Vasc. 2018 Apr-Jun;35(2):54-63. doi: 10.1016/j.hipert.2017.07.002. Epub 2017 Aug 4.
Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability.
The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation.
Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (P<0.0001), and -13.9±4.8 vs. -36.3±4.3mmHg (P<0.0001). The comparisons between Δ estimated glomerular filtration rate (eGFR) according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, were: +2.7±4.0 vs. +6.0±8.4mL/min/1.73m (P=0.2287), and +11.9±6.0 vs. +21.4±8.7mL/min/1.73m (P=0.0222).
The RSD reduced the mean 24-h ABPM in subjects with CKD and uncontrolled hypertension and improved the renal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC.
高血压既是慢性肾脏病（CKD）的共同病因，也是主要关注点。在合并CKD的情况下，血压控制更具挑战性。本研究使用EnligHTN导管和标准灌注式心脏消融导管（SICAC）Flexability，通过不同的消融点数，比较肾交感神经去支配术（RSD）对CKD合并未控制高血压患者24小时动态血压测量（ABPM）和肾功能的影响。
112名受试者根据手术中使用的导管随机分为两组：EnligHTN组（n = 56）或Flexability组（n = 56）。在每组中，根据消融点数创建5个亚组：4、8、12、16和20。对所有受试者进行为期6个月的随访，以评估本研究中测量的所有参数。
分别比较EnligHTN组和Flexability组消融点数为4和20时的24小时收缩压ABPM差值，差异分别为：-3.6±0.9 vs. -6.3±1.4mmHg（P<0.0001），以及-13.9±4.8 vs. -36.3±4.3mmHg（P<0.0001）。分别比较EnligHTN组和Flexability组消融点数为4和20时的估计肾小球滤过率（eGFR）差值，分别为：+2.7±4.0 vs. +（此处原文有误，应为+6.0±8.4）6.0±8.4mL/min/1.73m（P = 0.2287），以及+11.9±6.0 vs. +21.4±8.7mL/min/1.73m（P = 0.0222）。
RSD降低了CKD合并未控制高血压患者的24小时平均ABPM，并改善了两组患者的肾功能。在使用SICAC进行大量消融点的亚组中，这些效果更为显著和重要。
