经导管肾动脉消融去交感神经术对原发性高血压患者血压晨峰现象的影响研究

Effect of renal sympathetic denervation on the morning blood pressure surge in patients with primary hypertension

摘要:

目的： 探讨经导管肾动脉消融去交感神经术（renal sympathetic denervation，RDN）对原发性高血压患者血压晨峰现象的影响。方法： 收集重庆医科大学附属第二医院2017年1月至2020年6月确诊的高血压患者161例，根据血压晨峰水平，将患者分为晨峰组和非晨峰组。所有患者均给予RDN治疗。记录并比较2组患者治疗前及治疗后1 d、3 d、7 d、1个月、6个月、12个月血压晨峰，24 h平均收缩压及舒张压数值；治疗前、治疗后1个月的肾功能指标[血尿素氮（blood urea nitrogen，BUN）、肌酐（creatinine，Cr）、肾小球滤过率（estimated glomerular filtration rate，eGFR）]；术前和术后6个月的生活质量[健康状况调查问卷（the short form 36 health survey，SF-36）]；术后不良反应。结果： 治疗前，与非晨峰组比，晨峰组的BUN、Cr水平较高（P<0.05），eGFR水平较低（P<0.05）；治疗后，2组的BUN、Cr水平降低（P<0.05），eGFR水平增高（P<0.05），2组间BUN、Cr和eGFR差异无统计学意义（P>0.05）。治疗前，与非晨峰组比，晨峰组的血压晨峰差值、收缩压和舒张压明显增高（P<0.05）；治疗后，2组的血压晨峰差值、收缩压和舒张压均明显降低（P<0.05），2组间血压晨峰差值、收缩压和舒张压差异无统计学意义（P>0.05）。治疗前，与非晨峰组比，晨峰组的SF-36均明显降低（P<0.05）；治疗后，2组的SF-36均明显增高（P<0.05），2组间SF-36差异无统计学意义（P>0.05）。2组术后均接受随访，随访时间12个月，个别案例出现肾动脉狭窄、穿刺点血肿，经对症治疗均痊愈。结论： RDN可有效降低存在血压晨峰现象的原发性高血压患者的血压晨峰、收缩压及舒张压，明显改善患者肾功能及生活质量。

Abstract:

Objective: To investigate the effect of renal sympathetic denervation (RDN) on the morning blood pressure surge in patients with primary hypertension. Methods: A total of 161 patients diagnosed with hypertension in our hospital from January 2017 to June 2019 were collected in this study. According to levels of the morning blood pressure surge, the patients were divided into the morning blood pressure surge group and non-morning blood pressure surge group. All patients were treated with RDN. The morning blood pressure surge before treatment and 1 d, 3 d, 7 d, 1 month, 6 months and 12 months after treatment of the two groups, and 24 h average systolic blood pressure and diastolic blood pressure; the renal function indicators [blood urea nitrogen (BUN), creatinine (Cr), estimated glomerular filtration rate (eGFR)] before treatment and 1 month after treatment; the quality of life before and 6 months after surgery [the short form 36 health survey (SF-36)]; and adverse reactions after surgery were recorded and compared within the 2 groups. Results: Before the treatment, compared with the non-morning blood pressure surge group, the BUN and Cr were significantly increased (P<0.05), and the eGFR was significantly decreased (P<0.05) in the morning blood pressure surge group. After the treatment, the BUN and Cr were significantly reduced (P<0.05), the eGFR was increased (P<0.05) in both groups. There was no significant differences in BUN, Cr and eGFR between the 2 groups (P>0.05). Before treatment, compared with the non-morning blood pressure surge group, the morning blood pressure surge, systolic and diastolic blood pressure of the morning blood pressure surge group were significantly higher (P<0.05). After treatment, the morning blood pressure surge, systolic and diastolic blood pressure of 2 groups were significantly reduced (P<0.05). There was no significant differences in the morning blood pressure surge, systolic and diastolic blood pressure between the 2 groups (P>0.05). Before treatment, compared with the non-morning blood pressure surge group, the SF-36 of the morning blood pressure surge group was significantly reduced (P<0.05). After treatment, the SF-36 of 2 groups were significantly increased (P<0.05). There was no significant differences in the SF-36 between 2 groups (P>0.05). Both groups were followed up for 12 months after the surgery, a few cases had renal artery stenosis and hematoma after RDN, which were cured after symptomatic treatment. Conclusion: RDN can effectively reduce the morning blood pressure surge, systolic and diastolic blood pressure in hypertension patients, and significantly improve the renal function and quality of life for them.