OPRM1基因多态性对癌痛患者使用芬太尼透皮贴剂镇痛效应的影响  

The effect of OPRM1 gene polymorphism on analgesic potency of transdermal Fentanyl

作　　者：张群[1] 王守星[1] 黄桂春[1] 付海京[1] 陈龙邦[1] 

机构地区：[1]南京军区南京总医院肿瘤内科,南京210002

出　　处：《癌症进展》2015年第6期614-617,共4页Oncology Progress

基　　金：南京军区南京总医院科研基金(2010M040)

摘　　要：目的探讨OPRM1基因多态性对癌痛患者使用芬太尼透皮贴剂镇痛效应的影响。方法采用数字评分法(NRS)对123例癌痛患者使用芬太尼透皮贴剂前后的疼痛程度进行评估,记录患者NRS≤3时使用的剂量。利用聚合酶链反应-限制性片段长度多态性技术(PCR-RFLP)进行OPRM1多态性位点检测,比较不同基因型患者间使用芬太尼透皮贴剂镇痛剂量的差异。结果 OPRM1突变频率为32.9%。123例患者中有66例突变,其中野生纯合型(A/A型)患者57例(46.34%),突变杂合型(A/G型)患者51例(41.46%),突变纯合型(G/G型)患者15例(12.20%)。G/G型患者使用芬太尼透皮贴剂剂量与A/A型、A/G型相比明显增加,差异有统计学意义(P<0.05)。A/A型与A/G型患者使用芬太尼透皮贴剂剂量相比无显著性差异(P>0.05)。不同基因型组间不良反应发生率差异无统计学意义(P<0.05)。结论 OPRM1基因有可能成为预测癌痛患者使用芬太尼透皮贴剂疗效的一个重要参考指标,并为镇痛的个体化治疗提供理论依据。Objective To investigate the impact of OPRM1 gene polymorphism on the analgesic effect of trans-dermal Fentanyl. Method 123 cancer patients with pain were enrolled in this study, and the severity of pain before and after the administration of transdermal Fentanyl was then evaluated. The dose of transdermal Fentanyl used when NRS≤3 was recorded, and the inter-patient differences of dose were compared by detecting the polymorphic sites of OPRM1 allele with polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Result The mutation frequency of OPRM1 was 32.9%. Of the 123 patients, 66 had mutation, in which 57 （46.34%） cases had wildtype homozygotes （A/A）, 51 （41.46%） cases were with heterozygotes （A/G）, and 15 （12.20%） cases had mutant homozygotes （G/G） of OPRM1. The dose of transdermal Fentanyl required for G/G patients was remarkably higher than that of A/G patients, with significant differences observed （P〈0.05）. While the dose requirement between A/A and A/G patients was similar （P〉0.05）. There was no association between OPRM1 genetic polymorphisms and inci-dences of adverse drug reactions. Conclusion OPRM1 gene polymorphism is an effective predictor in estimating the patient ’s response to transdermal Fentanyl, which provides theoretical basis for individual therapy.

关 键 词：OPRM1基因 基因多态性 芬太尼透皮贴剂 镇痛 OPRM1 

分 类 号：R730.5[医药卫生—肿瘤]