经导管肾上腺消融治疗难治性继发性高血压

祝之明; 孙芳

doi:10.13201/j.issn.1001-1439.2024.08.001

经导管肾上腺消融治疗难治性继发性高血压

祝之明^1, ,,
孙芳¹

- 陆军军医大学大坪医院高血压内分泌科代谢性血管病重庆市重点实验室重庆市高血压研究所(重庆，400042)
基金项目:
国家自然科学基金(No：81920108010)

详细信息

通讯作者: 祝之明，E-mail：hbpcms@sina.com

中图分类号: R544.1

收稿日期: 2024-06-12

刊出日期: 2024-08-13

Catheter-based adrenal ablation remits resistant secondary hypertension

ZHU Zhiming^1, ,,
SUN Fang¹

- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, 400042, China

More Information

Corresponding author: ZHU Zhiming, E-mail: hbpcms@sina.com

Received Date: 12 June 2024

Publish Date: 13 August 2024

摘要

摘要: 原发性醛固酮增多症(PA)是继发性高血压的常见原因之一，其靶器官损害及心脑血管风险较原发性高血压更为严重，但相当部分PA患者存在药物疗效差或不能耐受，又不适合手术的难题，经导管肾上腺动脉消融有效解决了这一临床瓶颈问题。
- 原发性醛固酮增多症 /
- 经导管肾上腺消融术 /
- 难治性高血压
Abstract: Primary aldosteronism(PA) is one of the common causes of secondary hypertension, and its target organ damage and cardio-cerebrovascular risks are more severe than primary hypertension. However, a considerable number of PA patients suffer from poor medical efficacy or intolerance, and are not suitable for surgery. Transcatheter adrenal artery ablation effectively solves this clinical bottleneck problem.
- primary aldosteronism /
- adrenal ablation /
- resistant hypertension

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表 1 RDN与肾上腺消融术治疗难治性高血压的比较

Table 1. Comparison of RDN and adrenal ablation in treatment of resistant hypertension

项目	RDN	肾上腺消融术
适应证	难治性原发性高血压	难治性继发性高血压
血压	下降	下降
特异评价指标	交感神经活性	血肾上腺激素水平
治疗原理	抑制交感神经兴奋	减少肾上腺激素过多释放
技术方法	肾脏血管周围神经物理或化学消融	术前需行AVS确定优势侧，射频或经导管消融肾上腺
术后降压药	减量及减种类	减量及减种类，25%停药
不良反应	弥漫性动脉收缩、水肿和血栓，热损伤，如夹层	背腹部疼痛及消化道不适
指南或专家共识推荐	适合降压药治疗无效的难治性高血压	ⅡB，适合不能耐受药物治疗和无手术适应证者
治疗失败后的处理措施	寻求其他治疗方法	再次消融或外科手术切除病变肾上腺

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