《根据CYP2D6、OPRM1和COMT基因型选择阿片类药物治疗方案的临床药物遗传学实施联盟指南》解读

Interpretation of Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6,OPRM1,and COMT Genotypes and Select Opioid Therapy

阿片类药物被广泛用于中度至重度疼痛的治疗,然而其镇痛效果及不良反应存在广泛的个体差异。药物遗传学研究表明,基因多态性与上述个体差异有密切关系,研究较多的为CYP2D6、μ阿片受体(OPRM1)和儿茶酚-O-甲基转移酶(COMT)等基因的多态性。2021年2月,临床药物遗传学实施联盟(CPIC)发布了《根据CYP2D6、OPRM1和COMT基因型选择阿片类药物治疗方案的临床药物遗传学实施联盟指南》。该文对指南进行解读,总结CYP2D6、OPRM1和COMT基因多态性对阿片类药物镇痛效果和不良反应的影响,同时提出基于CYP2D6基因型指导临床使用可待因、曲马多和氢可酮等阿片类药物的治疗建议,以期为临床个体化用药提供参考。

Opioids are widely used in the treatment of moderate to severe pain.However,there are wide inter-individual variabilities in analgesic efficacy and adverse reactions.Pharmacogenetics study shows that gene polymorphism was closely related to the above interindividual variabilities,and more research was focused on CYP2D6(cytochrome P4502D6),μopioid receptor(OPRM1),and catechol-O-methyltransferase(COMT).In February 2021,the Clinical Pharmacogenetics Implementation Consortium(CPIC)issued Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6,OPRM1,and COMT Genotypes and Select Opioid Therapy.Therefore,to provide the basis for individualized clinical medication,this paper interprets the guidelines,including summarizing CYP2D6,OPRM1,and COMT gene polymorphism of opioid analgesic effect and adverse reactions and putting forward treatment suggestions based on CYP2D6 genotype to guide clinical use codeine,tramadol,and hydrocodone.