细胞色素P450氧化酶3A4＊1G基因多态性对新疆维吾尔族与汉族患者芬太尼术后镇痛效应的影响  

Influence of polymorphism of cytochrome P450 enzyme 3A4＊lG on fentanyl postoperative analgestic effect of Xinjiang Uygur and Han nationality patients

作　　者：徐维娟[1] 阿里木江·司马义 徐桂萍[1] 唐冬梅[1] 

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐830000 [2]新疆医科大学研究生学院

出　　处：《国际麻醉学与复苏杂志》2015年第7期618-622,共5页International Journal of Anesthesiology and Resuscitation

基　　金：新疆维吾尔自治区人民医院院内科研基金项目（20130126）

摘　　要：目的研究细胞色素P450氧化酶（cytochrome P450 enzyme，CYP）3A4＊IG在新疆维吾尔族及汉族人群的分布特征及其与芬太尼术后镇痛的用量及效果的关系。方法选择美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，在全身麻醉下行择期妇科手术的患者71例，按民族分为2组：维吾尔族组（U组）37例和汉族组（H组）34例。采用聚合酶链反应-限制性片段长度多态性（polymerase chain reaction-restriction hagment length polymorphism，PCR-RFlJP）技术进行CYP3A4＊IG基因多态性检测，统计其等位基因和基因型频率。术后采用芬太尼患者静脉自控镇痛（patientcontrolled intravenous analgesia，PCIA），记录并比较两组间术后6、24、48h的视觉模拟评分（visual analogue scale，VAS）、Ramasay镇静评分、生命体征、48h内患者PCIA芬太尼总用量。结果①U组患者中GG、GA、AA基因型分布频率分别为86．5％、10．8％和2．7％，H组患者中GG、GA、AA基因型分布频率分别为50．0％、44．1％和5．9％；U组患者G等位基因和A等位基因分布频率分别为91．9％和8．1％，H组患者分别为72．1％和27．9％；两组间基因型分布频率和等位基因分布频率差异均有统计学意义（P〈O．05）。②两组患者各时点（术后6、24、48h）脉搏血氧饱和度（pluseoxygensaturation，SpO2）、Ramasay镇静评分和VAS评分比较差异均无统计学意义。③U组PCIA48h内芬太尼总用量明显多于H组（R0．05）；U组和H组CYP3A4＊1G突变型（GA型＋AA型）PCIA48h内芬太尼总用量明显低于野生型（GG型）（P〈0．05）。结论CYP3A4＊1G基因多态性分布在新疆维吾尔族和汉族患者之间存在差异，此差异可能是两民族患者之间芬太尼术后镇痛效应出现差异的主要因素。Objective To study the distribution characteristics of cytochrome P450 enzyme（CYP）3A4＊ 1G in Xinjiang Uygur and Han nationality population, and their relationships with postoperative dosage of fentanyl and the analgesia effects. Methods seventy-one patients with gynecological surgery under general anesthesia were selected, ASA I or II. The patients were divided into two groups based on nationality： the Uighur nationality group （group U, n=37） and the Han nationality group （group H, n=34）. Polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） was adopted to detect the polymorphism of CYP3Ag＊IG. Patient controlled intravenous analgesia （PC1A） with fentanyl was adopted. And the visual analogue scale （VAS）, Ramsay sedation scores and vital signs at postoperative 6, 24 and 48 h and total amount of fentanyl within postoperative 48 h of PCIA were compared. Results （1） Distribution of 3 genotypes in group U（n=37） was： 86.5% of GG, 10.8% cases of GA and 2.7% of AA, and in group H （n=34）was： 50.0% of GG, 44.1% of GA, and 5.9% of AA. In group U, allele G accounted for 91.9% while allele A accounted for 8.1% o In group H, allele G accounted for 72.1% while allele A accounted for 27.9%, and there were statistically significant differences between the two groups （P〈0.05）. （2） There were no statistically significant differences between two groups of patients in pulse oxygen saturation（SpO2）, Ramasay scores and VAS scores at each time point. （3） Total amount of fentanylwithin 48 h of PCIA in group U was significantly greater than that of group H （P〈0.05）. And total amount of fentanyl within 48 h of PCIA in patients with mutant of CYP3A4＊ 1G （GA＋AA） of the two groups were significantly lower than that of the patients with wild GG genotype（P〈0.05）. Conclusions There are ethnic differences between Xinjiang Uygur and Han nationality in polymorphism of CYP3Ag＊IG, which may be the main factor that causes differences between na

关 键 词：维吾尔族 汉族 芬太尼 术后镇痛 细胞色素P450氧化酶3A4 基因多态性 

分 类 号：R614[医药卫生—麻醉学]