经皮肾动脉射频消融术对犬高血压影响机制的探讨

目的 实验证明交感神经活性增强与高血压的发生有关,我们研究的旨在探讨去神经术对犬高血压的治疗,并评估其有效性与安全性.方法18只杂种犬随机分为干预组(n=10)和对照组(n=8)两组,制作成高血压模型,干预组给予经皮肾交感神经去神经化治疗,实验对照组仅造成高血压模型,不行干预治疗.观察平均血压的变化,分别在术前和术后2、4、6、10周监测血压,同时在术后第2、6、10周监测血肾素活性、血管紧张素Ⅱ、醛固酮和肌酐等指标,通过对这些数据进行方差分析,来评价手术的有效性与安全性.结果在干预组,造模后平均血压增高明显,从(131.4±18.0)mm Hg(1 mm Hg =0.133 kPa)升至(150.6±18.8)mm Hg(P=0.001);在去神经治疗后,平均血压在2、4、6和10周后分别降至(130.4±14.1)mm Hg、(136.2-17.1)mm Hg、(128.7±14.7)mm Hg和(126.1±12.7)mm Hg.同时肾素活性,血管紧张素Ⅱ、醛固酮水平都较术前下降(P＜0.05),肌酐水平无明显变化(P＞0.05).对照组各项指标均无明显变化.结论交感神经兴奋在高血压的产生和发展过程中发挥着重要的作用,经皮肾动脉射频消融术能够产生显著和持久的血压下降,并且手术过程没有造成严重肾功能受损.

Efficacy of catheter-based renal denervation in mongrel neurogenic hypertensive dogs

Objective Hypertension is the most common risk factor for cardiovascular diseases and stroke.Renal sympathetic hyperactivity is associated with hypertension.The aim of this study was to explore the efficacy of renal denervation for hypertension.Methods Eighteen mongrel neurogenic hypertensive dogs were divided into intervention[mean arterial pressure:(150.6 ± 18.8)mm Hg(1 mm Hg =0.133 kPa)plus renal sympathetic denervation by percutaneous catheter-based radiofrequency,n =10]and control [mean arterial pressure(147.4 ± 13.2)mm Hg,n =8]group.Mean arterial pressure before and at 2,4,6 and 10 weeks after procedure was invasively measured.Renin activity(PRA),angiotensin](Ang Ⅱ),aldosterone(Ald),and creatinine(Cr)were detected at 2,6 and 10 weeks after procedure.Results Mean arterial pressure remained unchanged in control group.In intervention group,mean arterial pressure(MAP)decreased to(130.4 ± 14.1)mm Hg,(136.2 ± 17.1)mm Hg,(128.7± 14.7)mm Hg and(126.1 ± 12.7)mm Hg respectively at 2,4,6,and 10 weeks after procedure.Meanwhile,the level of PRA,AngⅡ,Ald significantly reduced post procedure compared with pre-procedural level(P ＜ 0.05)and the Cr level remained unchanged post procedure(P ＞ 0.05).Conclusion Synpathetic nervous system plays animportant role in the progression of hypertension.Catheter-based renal denervation results in substantial and sustained blood-pressure reduction in this model.