ABCB1基因C3435T多态性对手术患者术后阿片类药物使用量及镇痛效果影响的Meta分析
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篇名: ABCB1基因C3435T多态性对手术患者术后阿片类药物使用量及镇痛效果影响的Meta分析
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摘要: 目的:系统评价三磷酸腺苷结合盒转运体B亚家族成员1(ABCB1)基因C3435T多态性对手术患者术后阿片类药物使用量及镇痛效果的影响,为临床提供循证参考。方法:计算机检索Embase、PubMed、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库和万方数据库,收集ABCB1基因C3435T多态性与患者术后阿片类药物使用量及视觉模拟量表(VAS)评分相关性的回顾性研究,提取资料并按照纽卡斯尔-渥太华量表评价质量后,采用Rev Man 5.0统计软件进行Meta分析。结果:共纳入16项研究,合计2 885例患者。按照ABCB1 C3435T基因型检测结果分为野生纯合(CC)、突变杂合(CT)和突变纯合(TT)型。各遗传模型的Meta分析结果显示,ABCB1基因C3435T位点CC型与CT+TT型、CC+CT型与TT型、CC型与CT型、CC型与TT型、CC+TT型与CT型、C等位基因与T等位基因携带者术后24 h阿片类药物使用量及VAS评分比较,差异均无统计学意义(P>0.05)。按研究对象的种族进行亚组分析的结果显示,各基因型亚洲人群、非亚洲人群术后24 h阿片类药物使用量比较,差异均无统计学意义(P>0.05)。按手术类型进行亚组分析的结果显示,CC型与CT+TT型、CC+CT型与TT型、CC型与CT型、CC型与TT型、携带C等位基因与T等位基因的非妇科手术患者术后24 h阿片类药物使用量比较,差异均有统计学意义[SMD分别为0.32、0.35、0.24、0.45、0.26,95%CI分别为(0.03,0.61)、(0,0.70)、(0.02,0.46)、(0.02,0.88)、(0.01,0.51),P<0.05];而其余基因型妇科手术、非妇科手术患者术后24 h阿片类药物使用量比较,差异均无统计学意义(P>0.05)。结论:ABCB1基因C3435T多态性可能与患者术后24 h VAS评分无关,但携带T等位基因的非妇科手术患者术后24 h阿片类药物使用量可能更少,其多态性可以作为该类患者术后阿片类药物使用量的预测指标。
ABSTRACT: OBJECTIVE: To evaluate the effects of ABCB1 gene C3435T polymorphism on dose and analgesics sensitivity of opioids in surgery patients, and to provide evidence-based reference for clinic. METHODS: Retrieved from Embase, PubMed, Cochrane Library, CJFD, VIP and Wanfang database, retrospective studies on the relationship of ABCB1 gene C3435T polymorphism with the amount of opioids and VAS scores were collected. After data extraction and quality evaluation according to Newcastle-Ottawa scale, Meta-analysis was conducted by using Rev Man 5.0 statistical software. RESULTS: A total of 16 studies were included, involving 2 885 patients. According to ABCB1 C3435T genotype detection, there were wild homozygous genotype (CC), mutation heterozygous genotype (CT) and mutation homozygous genotype (TT). Results of Meta-analysis of ABCB1 gene C3435T site genetic model showed there was no statistical significance in 24 h amount of opioids or 24 h VAS scores after surgery between CC genotype and CT+TT genotype, between CC+CT genotype and TT genotype, between CC genotype and CT genotype, between CC genotype and TT genotype, between CC+TT genotype and CT genotype, between C allele and T allele (P>0.05). The subgroup analysis was conducted according to race of research object. Results of subgroup analysis showed that there was no statistical significance in 24 h amount of opioids among different genotypes of Asian population, non-Asian population (P>0.05). Subgroup analysis of the surgical types showed there was statistical significance in 24 h amount of opioids  after surgery in patients with non-gynecological surgery between CC genotype and CT+TT genotype, between CC+CT genotype and TT genotype, between CC genotype and CT genotype, between CC genotype and TT genotype, between C allele and T allele [SMD were 0.32, 0.35, 0.24, 0.45, 0.26, 95%CI were (0.03,0.61),(0,0.70),(0.02,0.46),(0.02,0.88),(0.01,0.51),P<0.05]. There was no statistical significance in 24 h amount of opioids after surgery among other different genotypes of patients with gynecological surgery and those with non-gynecological surgery (P>0.05). CONCLUSIONS: ABCB1 gene C3435T polymorphism may be not associated with 24 h VAS scores after surgery, but 24 h amount of opioids after surgery in T allele carriers with non-gynecological surgery may be decreased. Its polymorphism can be used as prediction index of the amount of opioids in this type patients after surgery.
期刊: 2018年第29卷第18期
作者: 吴成凤,申文,陈立平,刘尧,周娜,汪丹
AUTHORS: WU Chengfeng,SHEN Wen,CHEN Liping,LIU Yao,ZHOU Na,WANG Dan
关键字: 术后疼痛;ABCB1基因;C3435T;单核苷酸多态性;Meta分析;阿片类药物;使用量;VAS评分;种族;手术类型
KEYWORDS: Postoperative pain; ABCB1 gene; C3435T; Single nucleotide polymorphism; Meta-analysis; Opioids; Amount; VAS score; Race; Surgery type
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