去肾脏交感神经术对犬高血压的影响机制及有效性、安全性探讨

摘要

目的:通过去肾脏交感神经术(RSD)对犬高血压的治疗,探讨高血压与肾素-血管紧张素-醛固酮系统(RAS)的关系,并评估RSD的有效性与安全性.方法:18只杂种狗随机分为干预组(n=10)和对照组(n＝8)两组,干预组为高血压造模组,两组实验动物都接受RSD.观察的主要指标是平均动脉压(MAP)的变化,分别在术前和术后2、4、10周监测血压,同时在术后第2、6、10周监测肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肌酐(Cr)等指标,通过对这些数据进行方差分析,来评价RSD的有效性与安全性.结果:在干预组,造模后MAP增高明显,由(134.4±4.32)mmHg升至(153.8±7.2)mmHg(P＜0.001);在行RSD治疗后,MAP在2、4和10周后分别降至(137.6±8.46)mmHg、(132.3±6.20)mmHg和(125.5±2.87)mmHg,同时PRA、AngⅡ、ALD水平都较术前下降(P＜0.05),Cr水平无明显变化(P＞0.05).结论:RAS在高血压的发生和发展过程中发挥着重要的作用,RSD能够产生显著和持久的血压下降作用,能有效降低RAS的活性,并且手术过程没有造成严重肾功能受损.%Objective To explore the treatment of renal sympathetic denervation (RSD) for hypertension and assess the validity of the treatment, discussing the relation between hypertension and renin-angiotensin-aldosterone system(RAS) at the same time. Methods Eighteen mongrel dogs were studied as intervention (re = 10) and control (n= 8) groups, Ihe intervention group was made the neurogenic hypertension model, Iwo groups were received RSD. Primary endpoints were changes of mean blood pressure before and at 2,4 and 10 weeks after procedure. We assessed the effectiveness of renal sympathetic denervation with renin activity (PRA), angiotensin II (Ang II ), aldosterone(ALD), and creatinine(Cr) in the intervention group. The changes of PRA, Ang II , ALD, and Cr were detected at 2, 6 and 10 weeks after procedure. We assessed the data changes effectiveness by repeated measures ANOVA. Results In intervention group, mean arterial pressure (MAP) increased after making model [(134.4±4.32)mmHg vs. (153.8 ± 7.2)mmHg, P＜ 0.001]. MAP after catheter-based renal denervation decreased to (137.6 ± 8.46)mmHg, (132.3 ± 6.20)mmHg, (125.5 ± 2.87)mmHg at 2, 4 and 10 weeks, respectively. Meanwhile, the level of PRA, Ang II , ALD decreased compared with baseline level (P ＜ 0.05) and the Cr level did not change significantly (P＞ 0.05). Conclusions RAS plays an important role in the progression of hypertension. RSD causes substantial and sustained blood-pressure reduction, combined with RAS hyperactivity reduced, without serious renal impairment.