μ-阿片受体基因多态性与带状疱疹后神经痛患者疼痛敏感性及阿片类药物用量的关系

Associations of μ-opioid receptor gene polymorphism with pain sensitivity and opioid dosage in patients with postherpetic neuralgia

目的探讨μ-阿片受体基因(OPRM1)基因多态性与带状疱疹后神经痛(PHN)患者疼痛敏感性及阿片类药物用量的关系。方法收集带状疱疹(HZ)患者170例,并依据3个月后有无PHN分为PHN组(90例)和非PHN组(80例)。对可能影响PHN发生的因素进行logistic回归分析。比较PHN中、重度疼痛患者不同基因型间48 h阿片类药物用量、状态特质焦虑量表评分及睡眠质量评分。结果初治时间超过72 h、急性期重度疼痛、基因型GG是PHN发生的独立危险因素。PHN轻度疼痛、中度疼痛和重度疼痛组中,GG基因型分布频率明显升高;PHN中、重度疼痛组不同基因型患者48 h阿片类药物用量依次明显增加,且GG基因型患者用药量最多,差异均有统计学意义(P<0.05)。结论初治时间超过72 h、急性期重度疼痛、基因型GG是PHN发生的独立危险因素。OPRM1基因多态性可能是引起PHN患者阿片类药物药效学个体差异的遗传因素之一。

Objective To explore the associations of the polymorphism ofμ-opioid receptor gene(OPRM1)with pain sensitivity and opioid dosage in patients with postherpetic neuralgia(PHN).Methods The clinical data of 170 herpes zoster(HZ)patients who visited the pain clinic of our hospital from January 2019 to July 2022 were reviewed,90 of them put in the PHN group and 80 put in the non-PHN group according to the presence or absence of postherpetic neuralgia 3 months after HZ onset.The factors influencing the occurrence of PHN were analyzed by Logistic regression analysis.The two groups were compared in terms of 48h opioid dosage,sleep quality score and state trait anxiety score among different genotypes of PHN patients with moderate and severe pains.#The independent risk factors for PHN were found to include initial treatment>72 hours,severe pain in acute stage and genotype GG.The frequency of GG genotype distribution was significantly increased across the PHN mild pain,moderate pain and severe pain groups.As compared with the PHN moderate group,the 48 h dosage of opioids in the patients with different genotypes in the PHN moderate and severe pain group were significantly increased(P<0.05),with the highest in the GG genotype patients.Conclusion The independent risk factors for PHN are initial treatment>72 h,acute severe pain and genotype GG.The polymorphism of OPRM1 gene is the genetic factor that causes individual differences of opioid pharmacodynamics in PHN patients.