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| 阿片受体A118G基因多态性与经皮穴位电刺激镇痛效应的相关性 |
| Correlation between A118G gene polymorphism of opioid receptor and analgesic effect of transcutaneous electrical acupoint stimulation |
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| DOI：10.12089/jca.2022.07.004 |
| 中文关键词: 基因多态性 经皮穴位电刺激 μ阿片受体基因 镇痛效应 疼痛敏感性 |
| 英文关键词: Gene polymorphism Transcutaneous electrical acupoint stimulation μ opioid receptor gene Analgesic effect Pain sensitivity |
| 基金项目:温州市科技局项目（Y20190202） |
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| 中文摘要: |
目的 探讨μ阿片受体A118G基因（OPRM1 A118G）多态性与经皮穴位电刺激（TEAS）镇痛效应的相关性。
方法 选择择期行腹腔镜辅助经阴子宫切除术（LAVH）患者50例，年龄18～64岁，BMI 19～28 kg/m 2，ASA Ⅱ或Ⅲ级。所有患者接受全身麻醉，并于麻醉诱导前30 min于双侧足三里和三阴交穴位行TEAS，2/100 Hz疏密波、电流强度6～12 mA，直至手术结束。使用基因测序技术检测OPRM1 A118G基因多态性，根据基因型分为野生型纯合子组（AA组，n=20）、突变型杂合子组（AG组，n=25）和突变型纯合子组（GG组，n=5）。记录TEAS前即刻和刺激后30 min痛阈（PT）和耐痛阈（PTT），PT和PTT变化率，丙泊酚、顺式阿曲库铵、舒芬太尼、瑞芬太尼和总阿片类药物用量，术后2、4、6、12、24、48 h活动时VAS疼痛评分和补救镇痛情况。
结果 AA组20例，AG组25例，GG组5例。G等位基因频率为35%。AG组和GG组刺激前即刻PT明显低于AA组（P <0.05），刺激后30 min PT明显高于AA组（P <0.05），PT和PTT变化率明显高于AA组（P<0.05）。AG组和GG组总阿片类药物用量明显低于AA组（P<0.05），术后6、12 h AG组和GG组活动时VAS疼痛评分明显低于AA组（P<0.05）。三组刺激前即刻PTT，AG组和GG组刺激前即刻和刺激后30 min PT、PTT，AG组和GG组总阿片类药物用量，术后不同时点AG组和GG组活动时VAS疼痛评分差异无统计学意义。
结论 OPRM1 A118G基因突变可降低基础痛阈，但其对TEAS更敏感。TEAS的镇痛效应差异与OPRM1 A118G基因多态性有关。 |
| 英文摘要: |
Objective To investigate the correlation between μ opioid receptor A118G gene (OPRM1 A118G) polymorphism and transcutaneous electrical acupoint stimulation (TEAS) analgesia.
Methods Fifty patients scheduled for laparoscopic assisted vaginal hysterectomy, aged 18-64 years, BMI 19-28 kg/m 2, ASA physical status Ⅱ or Ⅲ, were selected. All the patients received general anesthesia, and TEAS was performed at bilateral Zusanli and Sanyinjiao 30 minutes before anesthesia induction, with 2/100 Hz density wave and current of 6-12 mA until the end of the operation. A118G polymorphism were screened for the participants, and were divided into 3 groups: wild-type homozygous group (group AA, n = 20), mutant heterozygous group (group AG, n = 25), and mutant homozygous group (group GG, n = 5) according to the genotype. The pain threshold (PT) and pain tolerance threshold (PTT) immediately before and 30 minutes after TEAS, the change rates of PT and PTT, the dosage of propofol, cisatracurium, sufentanil, remifentanil and total opioid, and the VAS score during exercise at 2, 4, 6, 12, 24, 48 hours after operation and the remedial analgesia were recorded.
Results It turned out that 20 cases in group AA, 25 cases in group AG, and 5 cases in group GG. G allele incidence was 35%. The immediate PT of groups AG and GG before stimulation was significantly lower than that of group AA (P < 0.05); meanwhile, the PT 30 minutes after stimulation in groups AG and GG was significantly higher than that of group AA (P < 0.05), and the change rates of PT and PTT were significantly higher than that of group AA (P< 0.05). Furthermore, the total opioid dosage in groups AG and GG were significantly lower than that of group AA (P < 0.05), the VAS score during exercise at 6, 12 hours after operation in groups AG and GG was significantly lower than that of group AA (P < 0.05). PTT immediately before stimulation among the three groups, PT and PTT immediately before and 30 minutes after stimulation in groups AG and GG, the total dosage of opioid in groups AG and GG, and the VAS score during exercise of groups AG and GG different time points after operation had no statistical significance.
Conclusion The A118G allele gene mutation in OPRM1 can reduce the basic pain threshold, but it is more sensitive to TEAS. The difference of analgesic effect of TEAS is related to OPRM1 A118G gene polymorphism. |
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