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JACC:去肾交感神经术意外发现

2013-12-18 佚名 医师报

德国萨尔大学tephan H Schirmer等开展的一项小型研究提示,顽固性高血压患者在接受去肾交感神经术(RDN)治疗后,左室肥厚和舒张功能均有显著改善,且这些方面的获益与血压和心率变化无关 Schirmer兴奋地表示,"该研究结果的新奇之处在于,心脏形态上的改善与血液动力学改变无关。"他认为,如果这些结果能在大规模研究中获得证实,那么RDN可能会增添新的适应证,

德国萨尔大学tephan H Schirmer等开展的一项小型研究提示,顽固性高血压患者在接受去肾交感神经术(RDN)治疗后,左室肥厚和舒张功能均有显著改善,且这些方面的获益与血压和心率变化无关。 【原文下载】

Schirmer兴奋地表示,"该研究结果的新奇之处在于,心脏形态上的改善与血液动力学改变无关。"他认为,如果这些结果能在大规模研究中获得证实,那么RDN可能会增添新的适应证,例如舒张性心衰。述评专家谨慎指出,尽管这些发现令人振奋,但鉴于该研究样本量较小,需要与假手术组对照的大规模研究来进一步评估,而且评估左室结构和功能要用心脏核磁共振检查,而非超声心动图检查。或许,美国哈佛大学医学院Deepak L Bhatt等开展的随机、双盲、多中心研究——SYMPLICITY HTN-3将会在2014年年中给出进一步的信息。

该研究入组66例接受RDN的顽固性高血压患者,受试者平均年龄64岁,在平均应用4.3种降压药的情况下诊室收缩压仍≥140 mm Hg.RDN术后6个月时,受试者的平均血压从172.9/92.5 mm Hg降至151.3/85.5 mm Hg,平均心率从67.7次/min降至60.5次/min,平均左室质量指数也从61.5 g/m2降至53.4 g/m2,舒张功能也得以显著改善。

研究者发现,受试者心率的变化与收缩压降幅相对应。然而,左室结构和舒张功能的改善幅度并不随收缩压和心率年华而明显改变,说明RDN在这两方面的获益与降压和心率减慢无关,同时也提示"交感神经系统对心肌形态和功能有直接影响".不过,血管并发症风险随血压降低而发生变化,但与心率减慢幅度无关。

原文出处:

Schirmer SH, Sayed MM, Reil JC, Ukena C, Linz D, Kindermann M, Laufs U, Mahfoud F, Böhm M.Improvements of left-ventricular hypertrophy and diastolic function following renal denervation - Effects beyond blood pressure and heart rate reduction.J Am Coll Cardiol. 2013 Nov 25. pii: S0735-1097(13)06233-5. doi: 10.1016/j.jacc.2013.10.073. 【原文下载】

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    2015-10-25 hlycom3356

    这篇文章写得非常好

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=40943, encodeId=ef6540943bb, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40944, encodeId=3ef340944f9, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40941, encodeId=7fe6409412e, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40942, encodeId=1d1840942f8, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35061, encodeId=e23235061b0, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=203, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:00:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967323, encodeId=17af196e32318, content=<a href='/topic/show?id=03513e279e5' target=_blank style='color:#2F92EE;'>#去肾交感神经术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37279, encryptionId=03513e279e5, topicName=去肾交感神经术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f503121, createdName=zjubiostat, createdTime=Sun Nov 16 17:31:00 CST 2014, time=2014-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6450, encodeId=6c9d645050, content=交感神经系统变更肯定会影响全身各器官,远期效果需进一步观察, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0dd92284, createdName=gts306, createdTime=Wed Dec 25 10:05:00 CST 2013, time=2013-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853262, encodeId=ec4a1853262f0, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Apr 14 18:31:00 CST 2014, time=2014-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6420, encodeId=2a8c6420ee, content=非常意外,这除了说明交感神经系统对心肌形态和功能有直接影响,可能的血流动力学改变与心脏形态功能的改变的平行性, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fba091956, createdName=Leeaimin99, createdTime=Fri Dec 20 08:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324870, encodeId=1a2f13248e00c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Dec 20 04:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=)]
    2015-10-25 hlycom3356

    这篇文章写得非常好

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=40943, encodeId=ef6540943bb, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40944, encodeId=3ef340944f9, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40941, encodeId=7fe6409412e, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40942, encodeId=1d1840942f8, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35061, encodeId=e23235061b0, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=203, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:00:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967323, encodeId=17af196e32318, content=<a href='/topic/show?id=03513e279e5' target=_blank style='color:#2F92EE;'>#去肾交感神经术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37279, encryptionId=03513e279e5, topicName=去肾交感神经术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f503121, createdName=zjubiostat, createdTime=Sun Nov 16 17:31:00 CST 2014, time=2014-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6450, encodeId=6c9d645050, content=交感神经系统变更肯定会影响全身各器官,远期效果需进一步观察, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0dd92284, createdName=gts306, createdTime=Wed Dec 25 10:05:00 CST 2013, time=2013-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853262, encodeId=ec4a1853262f0, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Apr 14 18:31:00 CST 2014, time=2014-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6420, encodeId=2a8c6420ee, content=非常意外,这除了说明交感神经系统对心肌形态和功能有直接影响,可能的血流动力学改变与心脏形态功能的改变的平行性, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fba091956, createdName=Leeaimin99, createdTime=Fri Dec 20 08:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324870, encodeId=1a2f13248e00c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Dec 20 04:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=)]
    2015-10-25 hlycom3356

    这篇文章写得非常好

    0

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    2015-10-25 hlycom3356

    这篇文章写得非常好

    0

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    2015-08-06 hlycom3356

    期待有更多研究

    0

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  7. [GetPortalCommentsPageByObjectIdResponse(id=40943, encodeId=ef6540943bb, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40944, encodeId=3ef340944f9, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:09:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40941, encodeId=7fe6409412e, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40942, encodeId=1d1840942f8, content=这篇文章写得非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Sun Oct 25 10:08:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35061, encodeId=e23235061b0, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=203, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:00:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967323, encodeId=17af196e32318, content=<a href='/topic/show?id=03513e279e5' target=_blank style='color:#2F92EE;'>#去肾交感神经术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37279, encryptionId=03513e279e5, topicName=去肾交感神经术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f503121, createdName=zjubiostat, createdTime=Sun Nov 16 17:31:00 CST 2014, time=2014-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6450, encodeId=6c9d645050, content=交感神经系统变更肯定会影响全身各器官,远期效果需进一步观察, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0dd92284, createdName=gts306, createdTime=Wed Dec 25 10:05:00 CST 2013, time=2013-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853262, encodeId=ec4a1853262f0, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Apr 14 18:31:00 CST 2014, time=2014-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=6420, encodeId=2a8c6420ee, content=非常意外,这除了说明交感神经系统对心肌形态和功能有直接影响,可能的血流动力学改变与心脏形态功能的改变的平行性, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fba091956, createdName=Leeaimin99, createdTime=Fri Dec 20 08:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324870, encodeId=1a2f13248e00c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Dec 20 04:31:00 CST 2013, time=2013-12-20, status=1, ipAttribution=)]
    2013-12-25 gts306

    交感神经系统变更肯定会影响全身各器官,远期效果需进一步观察

    0

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    2014-04-14 hbwxf
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    2013-12-20 Leeaimin99

    非常意外,这除了说明交感神经系统对心肌形态和功能有直接影响,可能的血流动力学改变与心脏形态功能的改变的平行性

    0

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