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目的探究去肾脏交感神经支配对心脏交感神经活动及神经密度分布的影响。方法选择2014年1月至2016年12月郑州人民医院诊治并确诊为顽固性高血压患者为研究对象,总计46例,男女比例为33∶13,平均降压药物(5.0±1.8)种,所有患者研究起始行I-123-MIBG显像,排除嗜铬细胞瘤;在行肾动脉去交感神经之前及之后12个月时评估心脏交感神经支配及相关活动,评估的指标为心脏至纵隔的比值(H/M)及洗脱率,同时记录患者的收缩压与24小时动脉血压变化情况。结果所有患者的诊所血压及平均动态收缩压均显著降低,分别由(182.5±20.2)mm Hg降至(142.3±19.6)mm Hg(P=0.013),(151.4±13.6)mm Hg降至(127.0±10.5)mm Hg(P=0.009);心脏的神经支配基本无显著变化,H/M平均值治疗前后为(2.47±0.40)vs(2.58±0.47)(P=0.277);心脏交感神经活性显著降低65.5%,WOR治疗前后数值为(23.7±11.6)%vs.(8.0±12.4)%(P=0.044);所有患者均表现出心脏交感神经的活动性降低。结论本研究初步证实去肾脏交感神经支配能够显著降低心脏的交感神经活动,可直接对心脏产生作用,相关的变化独立于血压产生的效应,可为相关研究提供病理生理学依据,有必要行进一步研究探究去肾脏交感神经支配对心律失常及心力衰竭的潜在影响。
Objective To investigate the effects of denervation of sympathetic innervation on sympathetic nerve activity and density distribution in the heart. Methods A total of 46 patients with refractory hypertension diagnosed and treated in Zhengzhou People’s Hospital from January 2014 to December 2016 were selected. A total of 46 patients were male and female, with a mean of 33:13 men and women (mean 5.0 ± 1.8). All patients Patient Study Initially I-123-MIBG imaging was performed to exclude pheochromocytoma; cardiac sympathetic innervation and related activities were assessed before and 12 months after denervation of the renal arteries, and the indicators for evaluation were cardiac to mediastinal Ratio (H / M) and elution rate, while recording the patient’s systolic blood pressure and 24-hour arterial blood pressure changes. Results All patients’ clinic blood pressure and mean systolic blood pressure decreased significantly from (182.5 ± 20.2) mm Hg to (142.3 ± 19.6) mm Hg (P = 0.013), (151.4 ± 13.6 mm Hg to 127.0 (P = 0.009). There was no significant change in the innervation of the heart. The H / M average was (2.47 ± 0.40) vs (2.58 ± 0.47) before and after treatment (P = 0.277) (65.5%). The values of WOR before and after treatment were (23.7 ± 11.6)% vs (8.0 ± 12.4)% (P = 0.044). All patients showed decreased sympathetic activity of the heart. CONCLUSIONS: This study initially demonstrated that denervated sympathetic nerves in the kidneys can significantly reduce the sympathetic activity of the heart and can directly affect the heart, with independent changes in blood pressure independent of the effects of blood pressure, providing a pathophysiological basis for the study and further study is needed Explore the potential effects of denervated sympathetic innervation on arrhythmias and heart failure.