新疆维吾尔族老年女性疼痛患者并发焦虑抑郁与OPRM1基因多态性的相关性

Correlation among anxiety,depression and OPRM1 gene polymorphism in elderly Uygur women with pain in Xinjiang

目的了解新疆维吾尔族老年女性疼痛患者合并焦虑、抑郁与OPRM1基因多态性的相关性,为新疆维吾尔族老年女性疼痛患者的治疗提供理论依据。方法采用随机数字表抽取样本,选取年龄65~80岁门诊女性患者,采用数字分级评分法(Numerical Rating Scale,NRS)对患者进行疼痛程度评估(将NRS评分≥1分的患者定义为疼痛患者),纳入存在不同程度疼痛患者1012例。采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS)对患者进行焦虑状态和抑郁状态评定。根据SAS评分和SDS评分,分别将患者分为焦虑组、非焦虑组,抑郁组、非抑郁组。采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)技术进行OPRM1基因多态性检测,统计其等位基因和基因型分布频率。使用电刺激仪进行痛阈和耐痛阈的测定。记录所有患者年龄,疼痛部位、程度(轻度疼痛、中度疼痛、重度疼痛)、病程(急性疼痛、慢性疼痛)等。结果①689例患者存在焦虑状态(68.1%),323例患者无焦虑状态(31.9%);焦虑组的年龄、慢性疼痛发生例数、NRS评分高于非焦虑组,差异有统计学意义(P<0.05),两组患者的痛阈、耐痛阈比较,差异无统计学意义(P>0.05);不同程度疼痛患者SAS评分比较,中度疼痛患者SAS评分和重度疼痛患者SAS评分高于轻度疼痛患者SAS评分,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄、疼痛部位、中度疼痛为焦虑的独立危险因素(P<0.05)。②306例患者存在抑郁状态(30.2%),706例患者无抑郁状态(69.8%);抑郁组患者的NRS评分高于非抑郁组,慢性疼痛发生例数低于非抑郁组,差异有统计学意义(P<0.05);两组患者年龄、痛阈、耐痛阈比较,差异无统计学意义(P>0.05);中度疼痛患者和重度疼痛患者SDS评分高于轻度疼痛患者SDS评分,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,疼痛部位、中度疼痛、重度疼痛为抑郁的独立危险因素(P<0.05)。③460例慢性疼痛患者按焦虑、抑郁情况分为4组[焦虑抑郁组(193例)、焦虑非抑郁组(102例)、抑郁非焦虑组(36例)、非焦虑非抑郁组(129例)],焦虑抑郁组患者NRS评分高于焦虑非抑郁组、抑郁非焦虑组、非焦虑非抑郁组,焦虑非抑郁组患者及抑郁非焦虑组患者NRS评分高于非焦虑非抑郁组患者,差异有统计学意义(P<0.05);各组间的痛阈、耐痛阈差异无统计学意义(P>0.05)。④OPRM1基因AA、AG、GG基因型分布频率为30.6%(409例)、55.5%(495例)、13.9%(108例),A、G等位基因型分布频率为58.3%、41.7%;OPRM1突变型(AA+AG)基因的疼痛患者并发焦虑、抑郁的可能高于OPRM1野生型(GG)基因的疼痛患者,OPRM1突变型(AA+AG)基因的疼痛患者多于OPRM1野生型(GG)基因。结论OPRM1野生型(GG)基因的女性疼痛患者合并焦虑或抑郁的例数低于OPRM1突变型(AA+AG)基因患者,说明新疆维吾尔族老年女性疼痛患者并发焦虑、抑郁与OPRM1基因多态性存在一定的相关性。

Objective To understand the correlation among anxiety,depression,and OPRM1 gene polymorphism in elderly Uygur women with pain in Xinjiang and to provide theoretical evidence for the treatment of elderly Uygur women with pain in Xinjiang.Methods The random number table sampling method was used to select female outpatients aged 65-80 years.The Numerical Rating Scale(NRS)was used to evaluate the pain degree of patients(patients with NRS score≥1 were defined as pain patients).A total of 1012 patients with pain at various degrees were included.The Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were used to assess the anxiety and depression of patients.According to SAS score and SDS score,the patients were divided into two groups:an anxiety group,a non-anxiety group,a depression group and a non-depression group.The polymorphism of the OPRM1 gene was detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),and its allele and genotype distribution frequency was counted.An electrical stimulator was used to measure the pain threshold and the pain tolerance threshold.Their age,location of pain,degrees(mild,moderate and severe pain),and courses(acute and chronic pain)were recorded.Results①A total of 689 patients suffered from anxiety state(68.1%),while 323 patients did not show anxiety state(31.9%).The age,number of cases of chronic pain,and NRS score of the anxiety group were remarkably higher than those of the non-anxiety group(P<0.05).There were no statistical differences in pain threshold and pain tolerance threshold between the two groups(P>0.05).For patients with pain at various degrees,patients with moderate and severe pain showed significantly higher SAS scores than those with mild pain(P<0.05).Multivariate Logistic regression analysis showed that age,pain site,and moderate pain were the independent risk factors for anxiety(P<0.05).②A total of 306 patients suffered from depression state(30.2%),while 706 patients did not show depression state(69.8%).The depression group presented significant higher NRS score and a lower number of cases of chronic pain than the non-depression group(P<0.05).There were no statistical differences in age,pain threshold and pain tolerance threshold between the two groups(P>0.05).The SDS scores of patients with moderate and severe pain were significantly higher than those with mild pain(P<0.05).Multivariate logistic regression analysis showed that the location of pain,moderate and severe pain were the independent risk factors for depression(P<0.05).③A total of 552 patients with chronic pain were divided into four groups according to their anxiety and depression(193,102,36 and 221 patients in the anxiety and depression group,the anxiety non-depression group,the depression non-anxiety group,and the non-anxiety non-depression group,respectively).The NRS scores of patients in the anxiety and depression group were higher than those in the anxiety non-depression group,the depression non-anxiety group and the non-anxiety non-depression group,while the NRS scores of patients in the anxiety non-depression group and depression non-anxiety group were higher than those in the non-anxiety non-depression group(P<0.05).There was no statistical difference in pain threshold and tolerance threshold among these groups(P>0.05).④The distribution frequency of AA,AG,and GG genotypes of the OPRM1 gene was 30.6%(409 cases),55.5%(495 cases),and 13.9%(108 cases).The distribution frequency of A and G alleles was 58.3%,and 41.7%,respectively.Pain patients with OPRM1 mutant(AA+AG)gene were more likely to suffer from anxiety and depression than those with OPRM1 wild type(GG)gene,while pain patients with OPRM1 mutant(AA+AG)gene were more likely to suffer from anxiety and depression than those with OPRM1 wild type(GG)gene.Conclusions The incidence of anxiety and depression in female pain patients with the OPRM1 wild type(GG)gene is lower than that carrying the OPRM1 mutant(AA+AG)gene,indicating that there is a certain correlation among anxiety,depression and OPRM1 gene polymorphism in Uygur elderly female patients with pain in Xinjiang.