国际麻醉学与复苏杂志   2019, Issue (7): 0-0
    
μ阿片受体、ATP结合盒B1基因、CYP3A基因多态性对恶性肿瘤患者术后舒芬太尼镇痛效应的影响
吴立强, 周瑞瑜, 王懿春, 杨金凤, 谭志荣, 李智, 刘景诗1()
1.湖南省肿瘤医院
Effects of mu?蛳opioid receptor, ATP?蛳banding cassette, subfamily B, member 1 gene, CYP3A genetic polymorphisms on sufentanil consumption in postoperative tumor patients
 全文:
摘要:

目的 探讨肿瘤患者术后舒芬太尼镇痛效应与μ阿片受体(mu-opioid receptor, OPRM1)、ATP结合盒B1基因(ATP-banding cassette, subfamily B, member 1 gene, ABCB1)、CYP3A基因多态性之间的联系。 方法 选择120例择期全身麻醉下行肿瘤切除术的患者,年龄19岁~65岁,ASA分级Ⅰ级、Ⅱ级,手术结束常规给予舒芬太尼静脉自控镇痛,术后2、6、12、24、48 h进行VAS评分,并计算舒芬太尼累计消耗量。检测OPRM1 118A>G、ABCB1 2677G>A/T、ABCB1 3435C>T、CYP3A4*1G和CYP3A5*3的等位基因。应用多元线性分析方法评估遗传和非遗传因素对舒芬太尼镇痛效应的影响。 结果 术后2、6、12、24、48 h内,患者VAS评分均与舒芬太尼累计消耗量有明显联系(P<0.05)。术后2、6、12、24、48 h舒芬太尼累计消耗量在OPRM1 118A>G、ABCB1 2677G>A/T、ABCB1 3435C>T、CYP3A4*1G和CYP3A5*3基因型组之间差异无统计学意义(P>0.05)。术后48 h舒芬太尼累计消耗量与年龄有明显的联系(P<0.05)。 结论 肿瘤术后患者使用舒芬太尼过程中,患者OPRM1,ABCB1和CYP3A基因多态性与术后舒芬太尼镇痛效应无相关性联系。

关键词: 遗传药理学; 舒芬太尼; CYP3A; μ阿片受体; ATP结合盒B1基因
Abstract:

Objective To investigate the association between postoperative sufentanil consumption and genetic polymorphisms of mu-opioid receptor (OPRM1), ATP-banding cassette, subfamily B, member 1 gene(ABCB1) and CYP3A in postoperative tumor patients. Methods A total of one hundred and twenty patients [American Society of Anesthesiologists (ASA) Ⅰor Ⅱ, aging 19 to 65] who were scheduled to undergo tumor surgery under general anesthesia were enrolled in this study. Intravenous patient-controlled analgesia with sufentanil was provided postoperatively. Cumulative sufentanil consumption was measured 2, 6, 12, 24 h and 48 h after surgery. The severity of pain was assessed with the Visual Analogue Scale(VAS), while OPRM1 118A>G, ABCB1 2677G>A/T, ABCB1 3435C>T, and CYP3A4*1G and CYP3A5*3 variant alleles were detected. The effects of genetic and non-genetic factors on sufentanil requirements were evaluated with multiple linear regression analysis. Results Patient VAS scores 2, 6, 12, 24 h and 48 h after surgery were obviously associated with cumulative sufentanil doses (P<0.05). The 48 h cumulative sufentanil dose after surgery was associated with age(P<0.05). Conclusions There was no association between OPRM1, ABCB1, CYP3A genetic polymorphisms and postoperative sufentanil consumption in tumor patients.

Key words: Pharmacogenetics; Sufentanil; CYP3A; Mu-opioid receptor; ATP-banding cassette, subfamily B, member 1 gene