经导管去肾神经治疗高血压：现状与挑战

摘要/Abstract

摘要：

经导管去肾神经术（renal denervation， RDN）是治疗高血压的新技术，近十几年来其已取得了显著进展。本文回顾国内外RDN治疗高血压主要随机对照临床试验证据，深入探讨了RDN疗法现存的关键问题，包括如何建立患者精准筛选体系，优化肾神经消融技术和术中评估肾神经阻断标准，以及开展心血管硬终点获益的大规模长期随访等。

关键词:经导管去肾神经术,高血压,治疗

Abstract:

Renal denervation (RDN) represents a novel therapeutic approach for hypertension and has made significant progress over the past decade. This study reviews the main evidence from domestic and international randomized controlled clinical trials of RDN for hypertension treatment and provides an in-depth exploration of the critical unresolved issues in RDN therapy. These include how to establish precise patient selection systems, optimize renal nerve ablation techniques and intraoperative evaluation standards for denervation efficacy, and conduct large-scale, long-term follow-up stu-dies to evaluate benefits on cardiovascular hard endpoints.

Key words:Renal denervation,Hypertension,Therapy

中图分类号:

R544.1

姜凯文, 董徽, 蒋雄京. 经导管去肾神经治疗高血压：现状与挑战[J]. 诊断学理论与实践, 2025, 24(05): 465-470.

JIANG Kaiwen, DONG Hui, JIANG Xiongjing. Renal denervation for treatment of hypertension： current status and challenges[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(05): 465-470.

图/表1

表1

可能有价值的RDN降压疗效预测因子及推荐意见

预测因子	推荐强度	理由或证据
交感神经兴奋度	+++	RDN理论基础，但目前尚无有效检测方法
基础心率	+	可作为交感神经兴奋度的关联指标
基础血压	++	RDN降压随机临床研究均支持
年龄	+	中青年一般交感神经兴奋度较老年人高
性别	±	缺乏研究验证
身体质量指数	±	不确定
肾素	++	高肾素与交感神经兴奋度强关联
动脉硬度	+	硬度大弹性低，可能RDN术后反应差
糖尿病	±	缺乏研究验证
肾小球滤过率	+	大多数RDN降压随机临床研究要求eGFR>40 mL/min
动脉粥样硬化	±	缺乏临床研究验证
阻塞性睡眠呼吸暂停	+	这类患者一般存在交感神经兴奋度高

表1

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