OPRM1 CYP3A基因多态性对芬太尼腹式子宫全切术镇痛效果的影响  

Association of OPRMI and CYP3A gene polymorphisms with fentanyl analgesic effect on abdominal hysterec-tomy

作　　者：梁惠霞 徐漾漾 包金荣 

机构地区：[1]瑞安市中医院妇产科,浙江省瑞安325200

出　　处：《中国基层医药》2014年第20期3078-3080,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨腹式子宫全切术患者μ阿片受体（OPRM1）基因、CYP3A基因多态性对芬太尼术后镇痛效果的影响。方法选取198例妇科择期全身麻醉下腹式子宫全切术患者，通过采用聚合酶链反应-限制性片断长度多态性技术检测术后芬太尼静脉镇痛消耗量与OPRM1和CYP3A基因多态性之间的关系。结果198例患者中，OPRM1分型成功的有186例，其余10例患者未能成功分型被剔除，其中A/A型89例， A/G型76例，G/G型21例，OPRM1 A118G等位基因频率为31．7％。 CYP3A4倡1/倡1、CYP3A4倡1/倡1G、CYP3A4倡1G/倡1G三组患者术后即刻及术后24 h平均VAS评分差异无统计学意义；术后第1个24 h芬太尼消耗量采用以方差分析体质量、年龄和术中芬太尼用量作为协变量等因素，三组患者之间差异有统计学意义（P＜0．05），CYP3A4倡1G/倡1G组低于CYP3A4倡1/倡1G组和CYP3A4倡1/倡1组，CYP3A4倡1/倡1G组和CYP3A4倡1/倡1组之间差异无统计学意义（P＞0．05）。另外，由于OPRM1 A118G与CYP3A4倡1G交互作用的存在，降低携带CYP3 A4倡1和OPRM1 A118 G/G者μ阿片受体表达数量，从而术后需要更多的芬太尼来达到相同的镇痛强度。结论分析妇科患者μ阿片受体基因A118G、CYP3A4倡IG多态性可以为临床应用芬太尼术后镇痛个体化用药提供参考。Objective To discuss the influence of μ-opioid receptor （ OPRM1） and CYP3A gene polymor-phism on analgesic effect of fentanyl for abdominal hysterectomy patients .Methods 198 cases of gynecologic anes-thesia patients who were treated by elective abdominal hysterectomy surgery ,were selected in the hospital .The rela-tionship between the fentanyl consumption of intravenous analgesia and OPRMI and CYP 3A gene polymorphisms was detected by using polymerase chain reaction-restriction fragment length polymorphism detection .Results In 198 pa-tients,OPRM1 genotyping was 186 cases,the other 10 patients failed to typing were excluded ,including 89 cases of type A/A,type A/G 76 cases,type G/G 21 cases,OPRM1 the frequency of A118G allele was 31.7%.No statistically significant differences were found in mean VAS score of CYP 3A4＊1/＊1,CYP3A4＊1/＊1G,CYP3A4＊1G/＊1G instantly after operation in the three groups and 24h postoperation.By using analysis of variance with body mass ,age and intraoperative volume as a covariate factors after first 24h fentanyl consumption ,the difference was statistically sig-nificant among the three groups （P〈0.05）,CYP3A4＊1G/＊1G group was significantly lower than that in CYP3A4＊1/＊1G group and CYP3A4＊1/＊1 group,there was no significant difference between CYP 3A4＊1/＊1G group and CYP3A4＊1/＊1 group （P〉0.05）.In addition,because the OPRM1 A118G interacts with CYP3A4＊1G, reducedthe quantity of expression of opioid receptor carrying CYP 3A4＊1 and OPRM1 A118G/G,and thus more fent-anyl was needed postoperation to achieve the same effect .Conclusion It provided a theoretical basis and reference for clinical application of personalized medicine by analyzing the gynecological patients μopioid receptor gene A118G and CYP3A4＊1G polymorphism.

关 键 词：OPRM1 CYP3A 基因多态性 芬太尼 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]