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中国实体器官移植术后高血压诊疗规范(2019版)

中华医学会器官移植学分会

中华医学会器官移植学分会. 中国实体器官移植术后高血压诊疗规范(2019版)[J]. 器官移植, 2019, 10(2): 112-121. doi: 10.3969/j.issn.1674-7445.2019.02.002
引用本文: 中华医学会器官移植学分会. 中国实体器官移植术后高血压诊疗规范(2019版)[J]. 器官移植, 2019, 10(2): 112-121. doi: 10.3969/j.issn.1674-7445.2019.02.002
Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for hypertension after solid organ transplantation in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(2): 112-121. doi: 10.3969/j.issn.1674-7445.2019.02.002
Citation: Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for hypertension after solid organ transplantation in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(2): 112-121. doi: 10.3969/j.issn.1674-7445.2019.02.002

中国实体器官移植术后高血压诊疗规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.02.002
基金项目: 

国家自然科学基金 81570680

国家自然科学基金 81372737

详细信息
    通讯作者:

    石炳毅,中国人民解放军总医院第八医学中心,Email:shibingyi666@126.com;马麟麟,Email:malinlin1009@126.com

  • 中图分类号: R617, R544.1

Diagnosis and treatment specification for hypertension after solid organ transplantation in China (2019 edition)

  • 摘要: 为了进一步规范中国实体器官移植术后高血压的诊断和治疗,中华医学会器官移植学分会组织器官移植专家和心血管病专家,在《实体器官移植受者的高血压诊疗指南(2015版)》的基础上,结合我国器官移植后高血压的临床现状,并参考《中国高血压防治指南》,从流行病学和发病率、定义和诊断标准、危险因素和病理生理、移植后高血压的治疗等方面,制定中国实体器官移植术后高血压诊疗规范(2019版)。

     

  • 表  1  血压水平的分类和定义

    Table  1.   Classification and definition of blood pressure levels(mmHg)

    类别 收缩压 舒张压
     正常血压 < 120 < 80
     正常高值 120~139 80~89
     高血压 ≥140 ≥90
       1级高血压(轻度) 140~159 90~99
       2级高血压(中度) 160~179 100~109
       3级高血压(重度) ≥180 ≥110
       单纯收缩压高 ≥140 < 90
    下载: 导出CSV

    表  2  常用免疫抑制剂导致移植术后高血压的相关机制

    Table  2.   Related mechanism of hypertension after transplantation caused by the immunosuppressant commonly used

    类别 药物 机制
    CNI
     
     
     
     
     
    他克莫司、环孢素
     
     
     
     
     
    提高血管张力:降低一氧化氮(nitric oxide, NO)、升高内皮素水平
    增加交感神经兴奋性
    激活血管紧张素-醛固酮系统:血压升高、水钠潴留
    激活远端小管的钠-氯协同转运受体:钠重吸收增加, 容量过多
    肾毒性:通过缩血管效应导致AKI
    慢性缺血、肾小球硬化、致间质纤维化和萎缩
    mTORi
     
     
    西罗莫司
     
     
    代谢异常:血脂、血糖异常
    致蛋白尿
    增加额外的CVE风险
    糖皮质激素
     
     
    甲泼尼龙
     
     
    增加交感神经兴奋性
    增加血管张力
    增加盐皮质激素活性
    下载: 导出CSV

    表  3  简化危险分层项目内容

    Table  3.   Project contents of simplified risk stratification

    项目 内容
    高血压分级
     
     
    1级:收缩压140~159 mmHg或舒张压90~99 mmHg
    2级:收缩压160~179 mmHg或舒张压100~109 mmHg
    3级:收缩压≥180 mmHg或舒张压≥110 mmHg
    危险因素 年龄、吸烟、血脂异常、早发心血管家族史、肥胖或腹型肥胖
    靶器官损害 左心室肥厚、颈动脉内膜增厚或斑块、血清肌酐轻度增高
    临床疾病 脑血管病、心脏病、肾脏病、周围血管病、视网膜病变、糖尿病
    下载: 导出CSV

    表  4  根据心血管总体危险量化估计预后危险度分层

    Table  4.   Prognostic risk stratification based on quantitative estimation of total cardiovascular risk

    其他危险因素、靶器官损害和疾病情况 高血压1级 高血压2级 高血压3级
    无其他危险因素 低危 中危 高危
    1~2个危险因素 中危 中危 高危
    ≥3个危险因素、靶器官损害、并存的临床疾病 高危 高危 高危
    下载: 导出CSV

    表  5  改变生活方式治疗的内容、目标和效果

    Table  5.   The content, goal and effect of lifestyle change therapy

    内容 目标 预期降压效果
    减少钠盐摄入 每日钠盐摄入量逐步降至 < 6 g/d, 肾功能正常者可适当补充钾盐 2~8 mmHg
    体育运动 强度:中等量, 每周3~5次, 每次30 min 4~9 mmHg
    合理膳食 营养均衡 8~14 mmHg
    控制体质量 BMI < 24 kg/m2, 腰围 < 90 cm (男性)、 < 85 cm (女性) 5~20 mmHg/减重10 kg
    戒烟 彻底戒烟、避免被动吸烟
    限制饮酒 每日白酒 < 50 mL, 或葡萄酒 < 100 mL或啤酒 < 300 mL, 建议戒酒 2~4 mmHg
     BMI为体质量指数
    下载: 导出CSV
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  • 收稿日期:  2018-11-18
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-03-15

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