OPRM1 A118G基因多态性对剖宫产术后小剂量右美托咪定镇痛效果的影响

The impact of OPRM1 A118G gene polymorphism on the analgesic effect of low-dose dexmedetomidine following cesarean delivery

目的探究OPRM1A118G基因多态性对剖宫产术后小剂量右美托咪定镇痛效果的影响。方法回顾性分析黄冈市中心医院于2021年1月至2023年6月收治的150例研究对象。根据评估结果,将所有研究对象划分为镇痛良好组(n=108)和镇痛不良组(n=42)。采用拟合优度χ^(2)检验验证数据的Hardy-Weinberg平衡。采用条件Logistic回归分析方法分析影响剖宫产术后小剂量右美托咪定镇痛效果的危险因素、基因型与镇痛指标间的相关性。结合Logistic回归结果,利用相乘及多因子降维法(MDR)分析其交互作用在镇痛效果预测中的效能。结果镇痛不良组中,AA基因型占比较低,为11.90%,而AG和GG基因型的占比则相对较高,分别为66.67%和21.43%。镇痛不良组中,G等位基因的频率显著增加,达到54.76%,A等位基因的频率则降低至45.24%。与基因型AA相比,AG基因型和GG基因型与镇痛不良的风险增加显著相关。在显性模式下(AG+GGvs.AA),镇痛良好组中AG+GG基因型占比明显低于镇痛不良组。在隐性模式下(GGvs.AA+AG),镇痛不良组中GG基因型占比显著高于镇痛良好组。累加模式分析结果显示,镇痛不良组中GG基因型的占比明显高于镇痛良好组,而AA基因型的占比则显著降低,GG、AG、AA基因型与镇痛效果之间具有显著相关性。OPRM1 A118G基因型GG为剖宫产术后镇痛不良的独立危险因素。在隐性模式中,GG基因型与SAI、术后48 h内小剂量右美托咪定总用量存在正相关关系(P<0.05),与痛阈存在负相关关系,其余模式中未发现明显相关性。存在SAI≥40分、术后48 h内小剂量右美托咪定总用量≥73μg、痛阈<3 mA、OPRM1 A118G基因型为GG的孕妇剖宫产术后出现小剂量右美托咪定镇痛效果不良的风险是不具有上述情况孕妇的3.59倍。结论OPRM1 A118G基因型GG为剖宫产术后镇痛不良的独立危险因素,与SAI、术后48 h内小剂量右美托咪定总用量存在正相关关系,与痛阈存在负相关关系。由SAI、术后48 h内小剂量右美托咪定总用量、痛阈、OPRM1 A118G基因型构建的镇痛效果预测模型具有较好的预测效果。

Objective To investigate the impact of OPRM1 A118G gene polymorphism on the analgesic effect of low-dose dexmedetomidine following cesarean delivery.Methods A retrospective analysis was conducted on 150 patients admitted to Huanggang Central Hospital from January 2021 to June 2023.Based on the assessment results,all patients were divided into a good analgesia group(n=108)and a poor analgesia group(n=42).The Hardy-Weinberg equilibrium of the data was verified using the goodness-of-fitχ^(2) test.The conditional Logistic regression analysis method was used to analyze the risk factors affecting the analgesic effect of low-dose dexmedetomidine after cesarean section,and the correlation between genotype and analgesic indicators.Combined with the results of Logistic regression,multiplicative interaction and multi-factor dimensionality reduction(MDR)were used to analyze the effectiveness of their interaction in predicting analgesic effects.Results In the poor analgesia group,the proportion of AA genotype was relatively low at 11.90%,while the proportions of AG and GG genotypes were relatively high at 66.67%and 21.43%,respectively.The frequency of the G allele was significantly increased to 54.76%,while the frequency of the A allele decreased to 45.24%in the poor analgesia group.Compared with the AA genotype,the AG and GG genotypes were significantly associated with an increased risk of poor analgesia.In the dominant model,the proportion of(AG+GG)genotype in the good analgesia group was significantly lower than that in the poor analgesia group.Under the recessive model(GG vs.AA+AG),the proportion of GG genotype was significantly higher in the poor analgesia group compared to the good analgesia group.The cumulative model analysis showed that the proportion of GG genotype was significantly higher in the poor analgesia group compared to the good analgesia group,while the proportion of AA genotype was significantly lower.There was a significant correlation between GG,AG,AA genotypes and analgesic effect.The OPRM1 A118G genotype GG were independent risk factors for poor analgesia following cesarean delivery.In the recessive model,the GG genotype was positively correlated with SAI and the total dose of low-dose dexmedetomidine within 48 hours,and negatively correlated with pain threshold.No significant correlation was found in other models.Pregnant women with SAI≥40 points,total dosage of low-dose dexmedetomidine≥73μg within 48 hours postoperatively,pain threshold<3 mA,and OPRM1 A118G genotype GG had a 3.59-fold increased risk of poor analgesic effect of low-dose dexmedetomidine following cesarean delivery compared to those without these factors.Conclusion OPRM1 A118G genotype GG is an independent risk factor for poor analgesia after cesarean section,which is positively correlated with SAI and the total dosage of low-dose dexmedetomidine within 48 hours after surgery,and negatively correlated with pain threshold.The analgesia effect prediction model constructed by SAI,the total dosage of low-dose dexmedetomidine within 48 hours after surgery,pain threshold,and OPRM1 A118G genotype has a good predictive effect.