MDR1 C3435T多态性对关节置换术后镇痛药物使用量的影响
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篇名: MDR1 C3435T多态性对关节置换术后镇痛药物使用量的影响
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摘要: 目的:探讨多药耐药基因1(MDR1)C3435T多态性对关节置换术后镇痛药物(地佐辛联合舒芬太尼)使用量的影响。方法:选取2014年1月-2016年2月在天津市人民医院和天津港口医院行关节置换术的患者300例,术后给予地佐辛+舒芬太尼联合镇痛。采用聚合酶链反应-限制性片段长度多态性分析法测定其MDR1 C3435T多态性,比较不同基因型患者术后视觉模拟量表(VAS)评分、镇静程度(Ramesy)评分、地佐辛+舒芬太尼的使用量,以及不良反应发生情况。结果:300例患者中,MDR1 C3435T CC、CT和TT基因型分别有100例(33.3%)、102例(34.0%)和98例(32.7%),各基因型频率均符合Hardy-Weinberg平衡(P>0.05)。各基因型患者术后0、24、48 h VAS评分、Ramesy评分比较,差异均无统计学意义(P>0.05),且未见镇静过度者。CT、TT基因型患者术后0~24、>24~48 h地佐辛+舒芬太尼的使用量均显著低于CC基因型患者,差异均有统计学意义(P<0.05);而CT与TT基因型上述各时间段药物使用量比较,差异均无统计学意义(P>0.05)。TT基因型患者术后恶心呕吐(PONV)及总体不良反应发生率均显著低于CC、CT基因型患者,差异均有统计学意义(P<0.05);而CC与CT基因型患者PONV及总体不良反应发生率,以及各基因型患者瘙痒的发生率比较,差异均无统计学意义(P>0.05)。结论:在达到相似镇痛、镇静效果的前提下,MDR1 C3435T突变型患者对地佐辛+舒芬太尼的耐受性更低,所需剂量更少,且不良反应发生率更低。该基因型可作为临床个体化治疗的参考指标。
ABSTRACT: OBJECTIVE: To investigate the effects of multidrug resistance gene 1(MDR1) C3435T polymorphism on the dose of  analgesia agents (dezocine combined with sufentanil) after joint replacement. METHODS: 300 patients receiving joint replacement were selected from Tianjin People’s Hospital and Tianjin Port Hospital during Jan. 2014-Feb. 2016. They were given dezocine and sufentanil for postoperative analgesia. PCR-RFLP was used to determine MDR1 C3435T polymorphism; VAS scores, Ramesy scores, the dose of dezocine+sufentanil and the occurrence of ADR were compared among different genotypes. RESULTS: Among 300 patients, there were 100 (33.3%), 102 (34.0%) and 98 (32.7%) cases of MDR1 C3435T CC, CT and TT genotype, respectively, the frequencies of which were all in line with Hardy-Weinberg balance (P>0.05). There was no statistical significance in VAS scores and Ramesy scores among different genotypes 0, 24, 48 h after surgery (P>0.05). No excessive sedation was found. The dose of dezocine+sufentanil in CT and TT genotype were all significantly lower than CC genotype 0-24 h, >24-48 h after surgery, with statistical significance (P<0.05). There was no statistical significance in drug dose between CT and TT genotype during above periods (P>0.05). The incidence of postoperative nausea and vomiting (PONV), ADR in TT genotype were significantly lower than CC and CT genotypes, with statistical significance (P<0.05). There was no statistical significance in the incidence of PONV and ADR between CC genotype and CT genotype, and in the incidence of itch among different genotypes (P>0.05). CONCLUSIONS: With similar sedation and analgesic effect, MDR1 mutant type have lower resistance to dezocine+sufentanil, and smaller drug dose is need, the incidence of ADR is lower. MDR1 genotype can be regarded as an important indicator of clinical individualized treatment.
期刊: 2017年第28卷第14期
作者: 王晓冰,刘永,李大祥
AUTHORS: WANG Xiaobing,LIU Yong,LI Daxiang
关键字: MDR1;基因多态性;关节置换术;术后镇痛;地佐辛;舒芬太尼;使用量;VAS评分;Ramesy评分
KEYWORDS: MDR1; Gene polymorphism; Joint replacement; Postoperative analgesia; Dezocine; Sufentanil; Dose; VAS score; Ramesy score
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