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目的观察高肾素水平的难治性高血压患者进行经皮经导管射频消融去肾交感神经术(RDN)的疗效。方法连续入选2011年6月至2013年7月在天津市第一中心医院心内科住院治疗的难治性高血压患者50例,行RDN,按照肾素水平分为高肾素组[≥0.79μg/(L·h),n=28]和低肾素组[<0.79μg/(L·h),n=22],比较两组患者术前及术后1、3、6、12月血压、肾素、血管紧张素Ⅱ、醛固酮、肌酐、尿常规和心率等指标的变化。结果高肾素组术后6、12月收缩压下降值、术后12月舒张压下降值高于低肾素组[分别下降(34.4±12.1)比(26.6±10.9)mm Hg,P=0.023;(36.5±12.3)比(27.7±11.3)mm Hg,P=0.015,(15.7±9.4)比(11.9±5.5)mm Hg,P=0.014],两组术后1、3月收缩压,1、3、6月舒张压下降值差异无统计学意义。高肾素组肾素、血管紧张素Ⅱ、醛固酮水平降低[分别下降(3.61±4.23)μg/(L·h),(33.9±29.3)ng/L,(36.3±31.4)ng/L,均P<0.05]。低肾素组血管紧张素Ⅱ、醛固酮水平下降[分别下降(32.2±33.8)ng/L,(34.0±29.1)ng/L,P<0.05],肾素水平差异无统计学意义。高肾素组基线肾素、血管紧张素Ⅱ水平明显高于低肾素组(均P<0.05)。术后无患者发生肾动脉狭窄、出血及血肿。结论高肾素水平的难治性高血压患者进行RDN能获得更好的降压效果。
Objective To observe the efficacy of percutaneous transcatheter radiofrequency ablation of renal allograft sympathectomy (RDN) in refractory hypertensive patients with high renin levels. Methods Fifty consecutive patients with refractory hypertension hospitalized in Department of Cardiology, First Central Hospital of Tianjin from June 2011 to July 2013 were enrolled in this study. RDN was divided into high renin group [≥0.79μg (L · h), n = 28] and the low renin group [<0.79μg / (L · h), n = 22]. The blood pressure was compared between the two groups before and after 1,3,6,12 , Renin, angiotensin Ⅱ, aldosterone, creatinine, urine and heart rate and other indicators of change. Results The decrease of systolic blood pressure in high renin group at 6 and 12 months postoperatively was higher than that in low renin group [(34.4 ± 12.1) vs (26.6 ± 10.9) mm Hg, P = 0.023 ; (36.5 ± 12.3) mm (27.7 ± 11.3) mm Hg, P = 0.015, (15.7 ± 9.4) vs (11.9 ± 5.5) mm Hg, P = 0.014] There was no significant difference in the diastolic blood pressure drop between March and June. The levels of renin, angiotensin Ⅱ and aldosterone in the high renin group decreased by 3.61 ± 4.23 μg / L, 33.9 ± 29.3 ng / L and 36.3 ± 31.4 ng / L, respectively P <0.05]. The levels of angiotensin Ⅱ and aldosterone decreased in low-renin group [(32.2 ± 33.8) ng / L and (34.0 ± 29.1) ng / L, respectively; P <0.05]. There was no significant difference in renin levels. The levels of baseline renin and angiotensin Ⅱ in high renin group were significantly higher than those in low renin group (all P <0.05). No postoperative renal artery stenosis, hemorrhage and hematoma. Conclusions RDN can achieve better antihypertensive effect in refractory hypertensive patients with high renin levels.