经皮肾动脉交感神经消融术后即刻肾静脉血相关生化指标的变化

The variation of renal venous biochemical indicators immediately after catheter-based renal sympathetic denervation

目的观察肾静脉、外周静脉、外周动脉血相关生化指标(肾素、醛固酮、去甲肾上腺素、肾上腺素)在经皮肾动脉交感神经消融术(RDN)后即刻的变化。方法 10头广西巴马小香猪。使用6FJR导引导管行左右肾动脉造影。以7F导引导管作为指引,置入5F温控射频消融导管,在左右肾动脉行RDN。消融模式:温控、50℃、8～10W,采用螺旋式消融,每个点消融60～90s,左、右肾动脉各消融4～6个点,相邻消融点间隔0.5cm。所有动物于术前和消融术后即刻行外周动脉、肾静脉、外周静脉取血,采集并检测去甲肾上腺素、肾上腺素、肾素、醛固酮水平。结果 RDN术后即刻的肾静脉血清肾素、醛固酮、肾上腺素水平分别为(389.6±208.7)、(337.1±156.8)和(313.4±113.2)ng/L,均显著低于术前水平[分别为(453.3±240.8)、(427.7±218.4)和(494.1±144.7)ng/L,P值分别<0.05、0.01],降幅分别为(14.3±0.6)%、(22.4±1.7)%和(22.5±0.9)%。RDN术后即刻和术前的血清去甲肾上腺素水平分别为292.5(625,49)、297.5(871,146)ng/L,差异无统计学意义(P>0.05),降幅为(1.7±0.2)%。肾静脉血的肾素、醛固酮、肾上腺素水平降幅均显著大于外周动脉和外周静脉血(P值均<0.05),外周动脉血与外周静脉血间上述指标的差异均无统计学意义(P值均>0.05)。结论与外周动脉、外周静脉相比较,肾静脉血相关生化指标在消融术后即刻出现显著下降,敏感性较高。

Objective To observe the variation of renal venous biochemical indicators such as renin, aldosterone, norepinephrine and epinephrine,in renal vein, peripheral vein and peripheral artery after catheter- based renal sympathetic denervation （RDN）. Methods Ten experimental miniature swine were used in this study. The 6F JR guiding catheter was used in renal angiography. The 7F guiding catheter was used as a guider in RDN, and 5F radiofrequency ablation catheter was placed in the bilateral renal arteries （model of ablation. 50 ℃, 60-90 s, 4- 6 points, adjacent the ablation point intervals 0. 5 cm）. Blood samples were collected from peripheral artery, renal vein and peripheral vein to evaluate the levels of norepinephrine, epinephrine, renin and aldosterone before and after RDN. Results The levels of renin, aldosterone and adrenaline were （389.6 ±208.7）, （337.1 ±156.8） and （313.4±113.2） ng/L after RDN, respectively. All of them were significantly lower than preoperative ones （[453.3±240.8], [427.7±218.4] and [494.1 ±144.7] ng/L, respectively, P〈0.05 or P〈0.01 ）. The decreasing amplitude was （ 14.3 ±0.6） %, （22.4 ±1.7） % and （22.5 ±0.9） %, respectively. There was no significant difference in serum norepinephrine before and after RDN （292.5 ±625, 49] ng/L vs. 297.5 [871, 146] ng/L, P〉0.05）. The decreasing amplitude of renal venous indicators was significantly larger than that in the periphery artery and vein （all P〈0. 05）, but there was no significant difference between periphery vein and artery （all P〈0.05）. Conclusion Compared with the peripheral artery and vein, the renal venous biochemical indicators are significantly declined after RDN, which indicates that the renal vein is more sensitive than peripheral artery and vein for RDN.