β_2肾上腺素能受体基因多态性与分娩镇痛时产程进展的相关性  

Correlation between the polymorphism of β_2-AR and the labor progress after labor analgesia

作　　者：李彩娟[1] 冯善武[1] 秦香[1] 张瑶[1] 沈晓凤[1] 

机构地区：[1]南京医科大学附属妇产医院(原南京医科大学附属南京妇幼保健院)麻醉科,210004

出　　处：《临床麻醉学杂志》2016年第8期738-741,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81500944);南京市卫生局一般性课题基金(YKK14127)

摘　　要：目的探讨β2肾上腺素能受体（β2-adrenergic receptor,β2-AR）基因多态性的分布,以及该多态性与分娩镇痛时产程进展的相关性。方法本研究为一项前瞻性观察研究,将165例2014年3~6月接受分娩镇痛的足月初产妇纳入本研究,通过聚合酶链反应-限制性片段长度多态性技术,检测β2-AR基因编码区第16、27位氨基酸变异位点,对产妇静脉血样本进行分析,获得对应的β2-AR基因多态性位点的等位基因频率,并记录人口学资料、缩宫素使用、产程进展及转剖宫产情况。结果本研究失访8例,DNA提取失败5例,余152例产妇获得基因多态性分型且资料完整,最终纳入分析。所获得的β2-AR基因多态性位点的等位基因频率,在16位点主要表现为Arg16Arg（AA）及Arg16Gly（AG）,在27位点主要表现为Gln27Gln（CC）。按照β2-AR基因多态性分组,各组人口学资料差异均无统计学意义。β2-AR 27位点不同基因组产妇产程进展及转剖宫产率差异均无统计学意义。β2-AR 16位点Arg16Arg组产妇第一产程及总产程时间均较Arg16Gly及Gly16Gly组明显延长（P〈0.05）,且转剖宫产率明显增加（P〈0.05）。多因素Logistic回归分析提示Arg16Arg基因纯合子转剖宫产率明显提高（OR 2.87,95%CI 2.65~3.09）。结论β2-AR Arg16Arg基因纯合子产妇的产程进展相对缓慢,可能是初产妇分娩镇痛后转剖宫产的重要危险因素之一。Objective To investigate the distribution of β_2-adrenergic receptor（ β_2-AR） genetic polymorphisms among the included parturient women and observe the relationship between the genetic polymorphisms and labor progress after labor analgesia. Methods A prospective observational study was conducted from March to June in 2014 at Nanjing Maternity and Child Health Care Hospital. A total of 165 nulliparous women were enrolled in the study,and finally 152 patients were included after exclusion for several reasons. The β_2-AR gene polymorphic variations at nucleotides encoding amino acids 16 and 27 were detected by polymerase chain reaction-restriction fragment length polymorphism technique. And the demographic data,rate of oxytocin usage,length of labor progress and the incidence of cesarean section after labor analgesia were observed and recorded. Results The allele frequencies of β_2-AR genetic polymorphism in the parturient women were dominantly presented in the form of Arg16Arg（ AA） and Arg16Gly（ AG） at 16 position and Gln27Gln（ CC） at 27 position respectively. The demographic and background characteristics of the subjects didn＇t present any significant differences among the groups with different β_2-AR genetic polymorphism. And the differences of labor progress among β_2-AR 27 genetic polymorphisms parturient women were not significant. However,the length of the first stage and the total labor progress in the β_2-AR Arg16 Arg homozygous were both significantly longer than that in the other two groups（ P〈0. 05）,and the incidence of cesarean section was also significantly higher（ P〈0. 05）. Furthermore,we also found that β_2-AR Arg16 Arg homozygous was related to cesarean delivery after labor analgesia through multivariate logistic regression analysis（ OR 2. 87,95% CI 2. 69-3. 09）. Conclusion The labor progress of the parturient women with β_2-AR Arg16 Arg homozygous is relatively slower,which maybe an important risk for the nulliparous women transforming to cesarean delivery

关 键 词：分娩镇痛 Β2肾上腺素能受体 基因多态性 产程 剖宫产 

分 类 号：R714.3[医药卫生—妇产科学]