肾动脉去交感神经术在治疗高血压中的研究进展

Progress of renal denervation in treatment of hypertension

长期以来,高血压的高发病率与低控制率之间的矛盾,是全世界普遍存在的问题,许多患者没能达到或维持在指南推荐的目标血压范围,肾动脉去交感神经术是一种降压新途径,弥补了传统口服降压途径的不足,近年来被广泛研究,该方法采用导管技术消融部分肾动脉周围神经,以减少交感神经活动达到降压目的。在该技术发展的过程中,也经历波折,目前发展到三种主要的手术方式,分别是:射频消融、超声消融以及酒精消融,经过多个全球多中心的试验,已被越来越多地证实是一种安全且耐受性良好的降低血压的血管内干预措施,最终改善心血管疾病的预后。同时也发现肾动脉去交感神经术对快速型心律失常、心力衰竭也可能存在重要的作用。本文总结了该手术可能的机制,重点归纳了当前该手术的分型及各自的临床证据,强调了其在全天候降低血压和减轻药物负荷方面的优势,指出了可能从该手术更多获益的高血压人群,并介绍了其未来可能应用于临床的更多方向。

For a long time,the contradiction between the high incidence and the low control rate of hypertension has been a global problem.Many patients failto achieve or maintain the target blood-pressure that guideline recommended.To make up for the shortcomings of the traditional antihypertensive route,renal denervation has been widely studied in recent years as anew way to control blood pressure,in which catheter-directed techniques are used to ablate portions of the renal artery to reduce sympathetic activity.In the process of development of this technology,there are also twists and turns.At present,it has developed into three main procedures,including radiofrequency ablation,ultrasound ablation and ethanol ablation.It has increasingly been shown to be a safe and well-tolerated intravascular intervention that reliably lowers blood pressure and ultimately improves cardiovascular outcomes.At the same time,renal denervation may also play an important role in tachyarrhythmia and heart failure.This review aims to discuss the possible principles of this strategy,summarizethe classification and clinical evidence of this procedure,emphasize the advantages in lowering blood pressure throughout 24 hours and reducing themedication burden,point out the people that may benefit more from the procedure and highlight the possible directions for its future application.