OPRM1 A118G基因多态性对肝门部胆管癌患者舒芬太尼术后镇痛效应的影响

Analgesic effect of OPRM1 A118G gene polymorphism on sufentanil in patients with hilar cholangiocarcinoma

目的探讨OPRM1 A118G基因多态性对肝门部胆管癌患者舒芬太尼术后镇痛效应的影响。方法50例静吸复合全麻下行肝门部胆管癌患者,术后采用病人自控镇痛舒芬太尼注射液2μg·kg-^1·h^-1。记录患者术后24 h、48 h的舒芬太尼用量及不良反应,并检测患者OPRM1A118G基因型,评估不同基因型患者舒芬太尼的镇痛效应。结果50例患者中,AA、AG及GG基因型比例分别为44%、40%及16%,A、G等位基因的频率分别为64%和36%。与AA基因型患者24 h、48 h的舒芬太尼用量47.12±11.39μg,88.76±19.27μg,相比,AG基因型患者均明显增加60.02±21.45μg,103.92±27.66μg,差异均有统计学意义(P<0.040,P<0.009),GG基因型患者分别为77.93±31.87μg及121.90±29.88μg,差异亦有统计学意义(P=0.031,P=0.002),恶心、呕吐及呼吸抑制发生率三组间无差异。结论OPRM1 A118G基因多态性影响肝门部胆管癌患者对舒芬太尼的镇痛效果。

Objective To investigate the analgesic effect of OPRM1 A118G gene polymorphism onsufentanil in patients with hilar cholangiocarcinoma.Method Fifty patients scheduled for elective hilarcholangiocarcinoma operation underwent combined intravenous and inhalationanesthesia.Patientcon.trolled analgesia(PCA)with sufentanil injection(2.00μg·kg^-1·h^-1)was used for post-operative analge.sia.The total dosage of sufentanil and adverse events were recorded at 24h and 48h after operation admin.istration.The OPRM1 A118G gene type were detected.Results Among 55 patients,the proportion ofAA,AG and GG genotype was 44%,40%and 16%,respectively.Distribution frequency of A and G allelewere 64%and 36%.The 24 h dosage of sufentanil in AG and GG genotype patients were both higher thanAA genotype patients 60.02±21.45μg vs 47.12±11.39μg,P=0.040,77.93±31.87μg vs 47.12±11.39μg,P=0.031.At 48 h,the dosage of sufentanil in AG and GG genotype patients were also significantly higherthan AA genotype patients103.92±27.66μg vs 88.76±19.27μg,P=0.009;121.90±29.88μg vs 88.76±19.27μg,P=0.002).There was no significant difference in adverse events between three groups(P>0.05).Conclusion The analgesic efficacy of sufentanil was affected with OPRM1 A118G gene polymorphismin patients with hilar cholangiocarcinoma.