肾交感神经活动及导管消融术治疗高血压研究进展

高血压是常见的心血管疾病之一,发达国家高血压人群的发病率为30%～40%,而发展中国家可能会更高~([1-2]).资料显示血压水平越高,发生心脑血管事件风险越大,并导致每年全球约710万人死亡~([3]).高血压患者中顽固性高血压占20%～35%~([4]),通常药物治疗效果很差.     

肾交感神经活动及导管消融术治疗高血压研究进展

高血压是常见的心血管疾病之一,发达国家高血压人群的发病率为30%～40%,而发展中国家可能会更高~([1-2]).资料显示血压水平越高,发生心脑血管事件风险越大,并导致每年全球约710万人死亡~([3]).高血压患者中顽固性高血压占20%～35%~([4]),通常药物治疗效果很差.     

肾动脉支架术的临床地位和争论

动脉粥样硬化是肾动脉狭窄最常见的病因,据估计在我国占所有肾动脉狭窄病因的70%左右~([1]),在欧美国家约占90%~([2]).动脉粥样硬化性肾动脉狭窄(ARVD)是引起老年人继发性高血压的常见原因之一,患病率占高血压人群的1%～3%,也是引起缺血性肾病,导致肾功能不全及终末期肾病的重要原因之一~([2]).     

阻塞性睡眠呼吸暂停综合征患者持续气道正压通气治疗的压力设定

成人OSAHS的发病率为2%～4%~([1]),睡眠结构破坏及睡眠时反复严重低氧血症可造成多系统损害.研究结果显示,OSAHS是冠心病、高血压、脑血管疾病及糖尿病的重要危险因素~([2-3]).     

不同年龄老年男性静息心率、血压、血脂水平的相关性

流行病学资料显示,65岁以上老年人中约2/3患有高血压~([1]).老年人高血压不仅发病率高,且为老年人心血管事件最重要的危险因素,常伴更高的病死率与病残率~([2]).另有研究认为血脂水平与血压之间存在正相关~([3]).但陈劲松~([4])等发现血脂水平与血压并不具有很好的正相关性,而且性别差异也不明显.另外针对静息心率(HR)与血压、血脂水平的相关关系研究较少.为此,本研究主要对不同年龄层次老年男性HR、血压、血脂水平及其之间的相关性进行探讨.     

64层螺旋CT血管成像技术诊断主动脉夹层56例临床价值

主动脉夹层(aortci dissection,AD)的确切发病率尚不清楚,尸检统计的发病率为2%～3%~([1]),在人群中的发病率为每年2.9/100 000~([2]).多数研究表明AD的发病年龄最常见于60～70岁,且临床症状很不典型,有时类似于心肌缺血,误诊率可高达38%,而且有28%的病人在死亡后尸体解剖中确诊~([3]).     

不可忽视生物燃料在慢性阻塞性肺疾病发病中的作用

一直以来,香烟在COPD发病中的作用受到高度重视~([1-2]).但是,25%～45%的COPD患者从不吸烟~([3]),说明除吸烟之外,室内外空气污染、职业粉尘暴露和儿童时期下呼吸道感染病史等,在COPD的发病中也具有重要作用~([4]). 近年来,生物燃料在COPD发病中的作用开始受到关注.生物燃料是指柴草、木头、木炭、庄稼杆和动物粪便等~([5]),其烟雾的主要有害成分包括碳氧化物、氮氧化物、硫氧化物和未燃烧完全的碳氢化合物颗粒和多环有机化合物等~([6]).     

血液透析患者容量负荷与动脉硬化的关系

慢性肾脏病不断进展最终导致终末期肾脏病(ESRD),需依赖透析或肾移植维持生命.心血管疾病(CVD)是透析患者死亡的主要原因~([1]),ESRD患者有50%以上死于CVD,而动脉硬化是CVD发病率和死亡率的最主要独立危险因素~([2]).血液透析(HD)患者,由于残余肾功能下降,未进行水盐控制,易出现容量超负荷,容量超负荷形成后可引起高血压、左心室肥厚甚至充血性心力衰竭~([3]).越来越多的证据表明,容量负荷与透析患者CVD的发病率及死亡率密切相关~([4]).最近Volker Wizemann等~([5])研究发现,在HD患者中容量负荷是决定患者预后的第二位影响因素,仅次于糖尿病.其中可能的机制就是容量负荷加重了动脉硬化的程度.     

心理干预对老年冠心病患者身心康复的影响

研究表明,70%～80%的老年疾病与心理因素有关,且心理因素对身必健康的影响越来越突出~([1]).     

老年人症状性颈动脉和椎动脉狭窄的血管内介入治疗

颈、椎动脉粥样硬化性狭窄是缺血性脑血管病的高危因素,其狭窄程度与卒中的危险程度成正相关~([1]).研究显示,60岁以上人群中0.5%存在颈动脉狭窄,>80岁者有10%存在颈动脉狭窄~([2]).椎动脉起始部的狭窄性病变仅次于颈动脉分叉处的颈内动脉狭窄而成为第2个常见的狭窄部位~([3]).     

The influence of catheter-based renal sympathetic denervation on renal function and renal arteries

ObjectiveCurrently investigated non-pharmacological minimally invasive method for the treatment of resistant hypertension is percutaneous denervation of renal sympathetic nerve fibres by radiofrequency catheter-based ablation. We assessed its influence on renal function and renal arteries.MethodsThe first 38 patients treated with catheter-based renal denervation at our centre between September 2011 and December 2012 were included in the study. Changes in renal function and changes in renal artery morphology at 12 months after the procedure have been analyzed.ResultsMean age was 57.6 ± 11 years, the majority (63.9%) were men. Average estimated glomerular filtration rates (eGF) were 1.25 ml/s/1,73 m² before denervation and 1.30 ml/s⁻¹/1.73 m⁻² 12 months after intervention. Changes in eGF did not reach statistical significance. New haemodynamically non-significant renal artery stenosis (40%) has occurred in only one case after procedure.ConclusionIn agreement with the results of several studies, our findings suggest that renal denervation (RDN) appears to be a safe therapeutic approach.     

Mild chronic renal insufficiency induces sympathetic overactivity.

The objectives of this study were to evaluate baseline sympathetic nerve activity as well as the mechanisms of sympathetic overactivity in mild chronic renal insufficiency hypertension. Seven hypertensives with mild renal insufficiency, seven hypertensives with normal renal function and seven normotensives, age and weight-matched were studied on one session to evaluate baseline muscle sympathetic nerve activity measured in the peroneal nerve. The mild renal insufficiency hypertensives and the hypertensives with normal renal function were also studied to evaluate arterial baroreflex control of muscle sympathetic nerve activity assessed by increasing and decreasing blood pressure through continuous infusion of phenylephrine and sodium nitroprusside respectively. Baseline muscle sympathetic nerve activity was significantly higher in mild renal insufficiency hypertensives (34 bursts/min) when compared to hypertensives with normal renal function (24 bursts/min) and to normotensives (16 bursts/min). Baroreflex control of muscle sympathetic nerve activity was (in absolute values) 15.2 in hypertensives with normal renal function vs 2.6 in mild renal insufficiency hypertensives (P < 0.05) during phenylephrine and 6.3 vs 8.2 during nitroprusside infusions. Mild renal insufficiency hypertensives showed sympathetic overactivity when compared to hypertensives with normal renal function and to normotensives. This finding demonstrates that elevated sympathetic activity may be precociously detected in renal insufficiency. Baroreflex gain to phenylephrine was blunted in mild renal insufficiency hypertensives when compared to hypertensives with normal renal function, suggesting that bradycardic response in mild renal insufficiency is blunted.     

Crossover in baroreflex pathways controlling renal sympathetic nerve activity

Experiments were performed to investigate the physiologic significance of the crossover of baroreceptor afferent input to the contralateral nucleus tractus solitarius (NTS) in terms of reflex control of renal sympathetic nerve activity and to determine the physiologic significance of neuronal crossover which may occur beyond the NTS. Experiments were done in 14 alpha-chloralose anesthetized rabbits. Baroreflex control of left renal nerve activity was determined from responses to phenylephrine-induced increases and nitroglycerin-induced decreases in arterial pressure. Under control conditions, the mean regression slope for changes in renal nerve activity (imp/sec/mmHg change in arterial pressure) was -2.2 +/- 0.5. After unilateral NTS lesion (n = 14) the gain of the reflex was -2.4 +/- 0.4 imp/sec/mmHg. Denervation of baroreceptors ipsilateral to the NTS lesion (n = 6) did not alter the regression slope (-2.7 +/- 0.5 imp/sec/mmHg), but interruption of the contralateral carotid and aortic baroreceptor afferent fibers (n = 8) markedly reduced the slope of the linear regression relationship from -2.4 +/- 0.3 to -1.1 +/- 0.3 imp/sec/mmHg. We interpret these data to suggest that baroreceptor afferent input exerts its major reflex influence via the ipsilateral NTS and that there is modest influence exerted by fibers which cross over to the contralateral side. In addition, since we recorded from the left renal nerves and alternated the side of the NTS lesion, we interpret our findings regarding a lesion in only one NTS to suggest that there is crossover in the baroreflex pathway beyond the NTS which permits the NTS on one side to exert an influence on the renal nerves on the contralateral side similar to that seen when the NTSs on both sides are intact.     

经皮肾去交感神经术治疗老年难治性高血压患者的临床研究

目的对老年难治性高血压患者行经皮肾去交感神经术(RSD),观察其有效性、安全性及可行性。方法选择连续难治性老年高血压患者20例,行经皮RSD,观察术前和术后1、3、6个月随访时的诊室血压变化;术前和术后动态血压、血清肌酐、估算的肾小球滤过率、肾素活性、血管紧张素Ⅱ和醛固酮变化;手术并发症发生情况。结果与RSD前比较,患者RSD后1、3、6个月随访时诊室血压分别下降了16.9/11.9、24.8/17.1、29.1/20.5mm Hg(1mm Hg=0.133kPa,P<0.01),术后动态血压下降了24.2/17.2mm Hg(P<0.01),肌酐和估算的肾小球滤过率无显著变化(P>0.05),肾素活性、血管紧张素Ⅱ和醛固酮显著下降(P<0.05);1例患者发生股动脉血肿。结论对老年高血压患者行经皮RSD可能安全、有效、可行。