肾动脉血流量对经皮肾动脉去交感神经术治疗慢性收缩性心力衰竭的疗效评估

Theraputic evaluation of renal artery blood flow for percutaneous renal artery denervation in the treatment of chronic systolic heart failure

目的:探讨肾动脉血流量对经皮肾动脉去交感神经术(RDN)治疗慢性收缩性心力衰竭患者的疗效评估作用。方法:本研究是一项前瞻性研究。纳入的18例患者皆被诊断为慢性收缩性心力衰竭,接受双侧RDN治疗。术前及术后即刻用基于X射线造影的三维重建血流量计算方法评估患者肾动脉血流的变化,并进行6个月的随访,观察患者6min步行距离、超声心动图指数、NYHA分级及脑钠肽等生化检查。并观察手术前、后肾血流量的变化与相关指标的关系。结果:6个月随访发现,RDN术后患者的6min步行距离[(247.33±93.34)m∶(355.06±119.14)m,P=0.002]和NYHA分级改善明显(P=0.006)。相关性分析发现,肾动脉血流量与左室射血分数(LVEF)、6min步行距离有相关性(P<0.05)。结论:RDN可能是一种有效的治疗慢性心力衰竭的新技术,可有效改善心功能,并且通过监测手术前后的肾动脉血流量变化可即刻评估RDN治疗的有效性。

Objective:To investigate the therapeutic evaluation of renal artery blood flow for percutaneous renal artery desympathy(RDN)treatment in patients with chronic systolic heart failure.Method:This study was a prospective study.All 18 patients were diagnosed with chronic systolic heart failure and received bilateral RDN therapy.Changes of renal artery blood flow before and after surgery were evaluated by X-ray angiography based threedimensional reconstruction blood flow calculation,and were followed up for 6 months.6-minute walking distance,echocardiographic indexes,NYHA classification and levels of brain natriuretic peptide were observed.The relationship between changes of renal blood flow before and after surgery and related indicators was analyzed.Result:After 6 months of follow-up,the 6-minute walk distance[(247.33±93.34)m vs(355.06±119.14)m,P=0.002]and the NYHA classification(P=0.006)in patients after RDN were improved significantly.Correlation analysis showed that there was also a correlation between renal blood flow and left ventricular ejection fraction and 6-minute walk distance(P<0.05).Conclusion:RDN may be a new effective technique for the treatment of chronic heart failure,which can effectively improve cardiac function.The effectiveness of RDN can be assessed immediately by monitoring the changes of renal artery blood flow before and after operation.