肾脏去神经治疗心力衰竭的进展

Renal Denervation Progress for Treatment of Heart Failure

心力衰竭是对全球健康有重要影响的疾病,尽管我们已经有多种药物和非药物方式来治疗心力衰竭,但是心力衰竭患者的生存率仍然为50%左右。临床上心力衰竭患者伴有肾功能不全的比例是很大的,且肾功能不全导致心力衰竭患者症状进一步加重。这种复杂的作用机制是心脏和肾脏之间的病理生理失衡所致,心脏疾病促进肾功能损害,肾功能的损害进而反馈,加重心血管疾病,二者之间形成一个恶性循环。多种神经体液及血流动力学机制参与这种心肾功能的反馈,包括心脏钠尿肽的减少,增加水钠潴留,增加机体的容量和改变器官的重塑。在动物实验中证实了肾脏去神经术促进心力衰竭动物的水钠潴留,减轻心脏负荷,改善心脏功能。随着经导管去神经技术的研发,此技术有望在临床上应用,改善心力衰竭患者的心脏功能,尤其是在有药物禁忌证的心力衰竭患者中。

Heart failure is a disease that has important effects on global health .Although we have a variety of drug and non-drug methods to treat heart failure ,the survival rate for such patients remains around 50%.There is a large proportion of clinical heart failure pa-tients with renal dysfunction , and heart failure combined with renal insufficiency have symptoms that are further aggravated .The complex mechanism of action between heart and kidney is a pathological physiological imbalance caused heart disease to promote kidney damage ,kid-ney damage,and in turn,feedbacks and increases cardiovascular disease ,forming a vicious circle between them .Various neurohumoral and hemodynamic mechanisms are involved in this kind of heart kidney feedback ,including decreasing cardiac natriuretic peptides ,which increase water sodium retention ,the capacity of the body and change the reshaping of the organ .Animal experiments confirmed that the renal denerva-tion promote heart failure animal water sodium retention ,reduce cardiac load ,and improve cardiac function .With the development of the cath-eter to neural technology ,this technology in clinical application ,will improve cardiac function in patients with heart failure ,especially in pa-tients that have drug contraindication with heart failure .