国际麻醉学与复苏杂志   2019, Issue (2): 0-0
    
儿茶酚氧位甲基转移酶基因rs4680多态位点与乳腺癌切除手术术后疼痛的相关性分析
蒋铭, 杨现会, 王军, 周彪, 颜朋朋1()
1.郑州大学第二附属医院麻醉科
Analysis on the correlation between rs4680 polymorphic site of catechol-O-methyl transferase and postoperative pain of mastectomy
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摘要:

目的 探讨儿茶酚氧位甲基转移酶 (catechol-O-methyl transferase, COMT)基因rs4680多态位点与术后疼痛的关系,为个性化用药提供理论依据。 方法 择期全身麻醉行乳腺癌切除手术患者83例,年龄29~58岁,ASA分级Ⅰ、Ⅱ级。采用聚合酶链反应-限制性片段长度多态性技术(polymerase chain reaction-restriction fragment length polymorphism, PCR-RFLP)对83例患者COMT基因rs4680位点进行基因型鉴定,根据基因类型将患者分为野生型Val/Val(VV,51例)、杂合型Val/Met(VM,23例)和突变型Met/Met(MM,9例);采用同源建模对突变前后蛋白质的三级结构进行预测,并对蛋白理化性质进行分析。采用统一的静吸复合麻醉方案进行术前麻醉,术后行患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA),记录24 h内镇痛泵的有效及无效按压次数,并用疼痛数字评分法(Numerical Rating Scale, NRS)评估不同基因型术后2、4、8、24 h疼痛情况。 结果 COMT基因rs4680突变对蛋白三级结构无明显改变,但对蛋白的部分理化性质有所影响。术后24 h内MM患者PCIA总按压次数明显高于VV患者和VM患者(P<0.05),MM患者PCIA有效按压次数明显高于VV患者(P<0.05),但3种基因型患者PCIA按压有效率差异无统计学意义(P>0.05)。术后各时点3种基因型患者NRS评分比较,差异均无统计学意义(P>0.05)。 结论 COMT基因单个多态位点rs4680可能对乳腺癌患者术后疼痛的个体化差异影响不大。

关键词: 儿茶酚氧位甲基转移酶; 基因多态性; 同源建模; 术后疼痛; 乳腺癌
Abstract:

Objective To explore the correlation between rs4680 polymorphic site of catechol-O-methyl transferase (COMT) gene and postoperative pain so as to provide theoretical evidence for individualized medicine. Methods A total of eighty-three patients [aging 29-58, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ] scheduled for mastectomy under general anesthesia was selected. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) was adopted to identify their genotype of rs4680 polymorphic site of COMT. The patients were divided as a wild-type group(Val/Val, VV, n=51), a hybrid subtype group (Val/Met, VM, n=23) and a mutation-type group(Met/Met, MM, n=9). Then the tertiary structures of COMT protein before and after mutation were predicted through homology modeling and the physicochemical property of the protein was analyzed. Preoperative anesthesia was conducted by intravenous-inhalation combined anesthesia and postoperative anesthesia by patient controlled intravenous analgesia (PCIA). The number of effective and ineffective compressions of the analgesic pump within 24 h was recorded. Patients′ pain was assessed 2, 4, 8 h and 24 h after operation by the Numerical Rating Scale (NRS) and then its correlation with different genotypes was analyzed. Results The mutation of rs4680 polymorphic site of COMT has no significant effects on tertiary structures of COMT protein but it affected the physicochemical property of COMT protein. MM patients showed remarkably more PCIA press time than VV and VM patients 24 h after surgery (P<0.05). MM patients presented markedly more PCIA effective press time than VV patients (P<0.05). There was no significant difference in NRS score between the three genotypes at each postoperative point. Conclusions Single polymorphic site rs4680 may have little influence on individual difference of postoperative pain for patient with breast cancer.

Key words: Catechol-O-methyl transferase; Gene polymorphism; Homology modeling; Postoperative pain; Breast cancer