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学科主题: 临床医学
题名:
The Impact of Genetic Variation on Sensitivity to Opioid Analgesics in Patients with Postoperative Pain: A Systematic Review and Meta-Analysis
作者: Ren, Zhen-Yu1; Xu, Xiao-Qing1,6; Bao, Yan-Ping4,5; He, Jia2,3,4,5; Shi, Le2,3,4,5; Deng, Jia-Hui2,3,4,5; Gao, Xue-Jiao2,3; Tang, Hui-Lin1; Wang, Yu-Mei2,3; Lu, Lin2,3,4,5
关键词: Postoperative pain ; meta-analysis ; single-nucleotide polymorphism ; opioid
刊名: PAIN PHYSICIAN
发表日期: 2015-03-01
卷: 18, 期:2, 页:131-152
收录类别: SCI
文章类型: Review
WOS标题词: Science & Technology
类目[WOS]: Anesthesiology ; Clinical Neurology
研究领域[WOS]: Anesthesiology ; Neurosciences & Neurology
关键词[WOS]: CATECHOL-O-METHYLTRANSFERASE ; SINGLE-NUCLEOTIDE POLYMORPHISM ; MU-OPIATE RECEPTOR ; MAJOR ABDOMINAL-SURGERY ; MORPHINE CONSUMPTION ; A118G POLYMORPHISM ; OPRM1 A118G ; CHINESE POPULATION ; CYP2D6 GENOTYPE ; CANCER-PATIENTS
英文摘要:

Background: Individual response to opioid analgesics varies among patients.

Objective: This study sought to clarify the impact of distinct genetic variations on pain, opioid consumption, and opioid side effects in patients with postoperative pain.

Study Design: A systematic review and meta-analysis of associations between genetic single-nucleotide polymorphisms (SNPs) and opioids used for acute postoperative pain.

Setting: This meta-analysis examined all studies involving an association between genetic polymorphisms and the analgesic efficacy or clinical outcome of opioid analgesics for postoperative pain.

Methods: A literature search was performed up to January 31, 2014, using the PubMed, EMBase, ISI Web of Science, and Cochrane Library databases.

Results: Fifty-nine studies were included in this systematic review, and 23 studies (a total of 5,902 patients) were included in the final meta-analysis. The results showed that human mu-opioid receptor gene (OPRM1) 118G allele variant carriers consumed more opioids for analgesia (SMD = -0.17, 95% CI = [-0.25, -0.10], P < 0.00001), but reported higher pain scores (MD = -0.11, 95% CI = [-0.17, -0.04], P = 0.002) and less nausea and vomiting (odds ratio = 1.30, 95% CI = [1.08, 1.55], P = 0.005) than the homozygous 118AA patients during the first 24 hour but not the 48 hour postoperative period. Moreover, CYP3A4(star)1G carriers consumed less opioids than homozygous CYP3A4(star)1/(star)1 patients during the first 24 hours postoperative period (MD = 45.12, 95% CI = [36.17, 54.06], P < 0.00001). No significant differences were found in CYP3A5(star)3, ABCB1 C3435T, and G2477T/A genetic polymorphisms.

Limitations: Some potential non-genetic factors can modify the effects of gene SNP on pain and opioid consumption during the postoperative period, such as age, gender, mood, anxiety, and drug-drug interactions. But further analyses could not be performed in the present meta-analysis due to limited information.

Conclusion: The results indicate that among the genetic SNPs we studied which include those affecting analgesic drug metabolism, transport of analgesic agents across the blood-brain barrier, and their activity at target receptors and ion channels and in the modulation of neurotransmitter pathways, the A118G allele variant of OPRM1 has the most potent influence on pain management of postoperative patients. Opioid receptor gene information may provide valuable information for clinicians to properly manage the analgesic use of opioids individually for better pain management.

语种: 英语
所属项目编号: 81300948 ; 20120001120072
项目资助者: National Natural Science Foundation of China ; Research Fund for the Doctoral Program of Higher Education by Ministry of Education, China ; Foundation of Peking University Third Hospital, China
WOS记录号: WOS:000351560000002
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/55663
Appears in Collections:北京大学第三临床医学院_药剂科_期刊论文

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作者单位: 1.Peking Univ, Hosp 3, Dept Pharm, Beijing 100191, Peoples R China
2.Peking Univ, Inst Mental Hlth, Beijing 100191, Peoples R China
3.Peking Univ, Hosp 6, Inst Mental Hlth, Beijing 100191, Peoples R China
4.Peking Univ, Key Lab Mental Hlth, Beijing 100191, Peoples R China
5.Peking Univ, Natl Inst Drug Dependence, Beijing 100191, Peoples R China
6.Peking Univ, Dept Pharm Adm & Clin Pharm, Hlth Sci Ctr, Beijing 100191, Peoples R China

Recommended Citation:
Ren, Zhen-Yu,Xu, Xiao-Qing,Bao, Yan-Ping,et al. The Impact of Genetic Variation on Sensitivity to Opioid Analgesics in Patients with Postoperative Pain: A Systematic Review and Meta-Analysis[J]. PAIN PHYSICIAN,2015,18(2):131-152.
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