Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, Western Australia.
Department of Radiology, Alfred Hospital.
J Hypertens. 2021 Aug 1;39(8):1478-1489. doi: 10.1097/HJH.0000000000002839.
Sympathetic overdrive plays a key role in the perturbation of cardiometabolic homeostasis. Diet-induced and exercise-induced weight loss remains a key strategy to combat metabolic disorders, but is often difficult to achieve. Current pharmacological approaches result in variable responses in different patient cohorts and long-term efficacy may be limited by medication intolerance and nonadherence. A clinical need exists for complementary therapies to curb the burden of cardiometabolic diseases. One such approach may include interventional sympathetic neuromodulation of organs relevant to cardiometabolic control. The experience from catheter-based renal denervation studies clearly demonstrates the feasibility, safety and efficacy of such an approach. In analogy, denervation of the common hepatic artery is now feasible in humans and may prove to be similarly useful in modulating sympathetic overdrive directed towards the liver, pancreas and duodenum. Such a targeted multiorgan neuromodulation strategy may beneficially influence multiple aspects of the cardiometabolic disease continuum offering a holistic approach.
交感神经过度兴奋在破坏心脏代谢稳态方面起着关键作用。饮食诱导和运动诱导的体重减轻仍然是对抗代谢紊乱的关键策略，但往往难以实现。目前的药物治疗方法在不同的患者群体中产生不同的反应，长期疗效可能受到药物不耐受和不依从性的限制。临床需要补充疗法来减轻心脏代谢疾病的负担。一种这样的方法可能包括对与心脏代谢控制相关的器官进行介入性交感神经调节。基于导管的肾脏去神经研究的经验清楚地证明了这种方法的可行性、安全性和有效性。类似地，人类现在可以对肝总动脉进行去神经支配，并且可能在调节肝脏、胰腺和十二指肠的交感神经过度兴奋方面同样有用。这种针对多器官的神经调节策略可能会有益地影响心脏代谢疾病连续体的多个方面，提供一种整体方法。
