评估β-2肾上腺素能受体基因密码子16多态性对接受蛛网膜下腔麻醉的孕妇发生动脉低血压及使用麻黄碱情况的影响。

Evaluation of the influence of the codon 16 polymorphism of the Beta-2 adrenergic receptor gene on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid anesthesia.

作者信息

Magalhães Edno, Gomes Maurício Daher Andrade, Barra Gustavo Barcelos, Govêia Cátia Sousa, Ladeira Luis Cláudio Araújo

机构信息

CET/SBA of the Center of Anesthesiology of the Hospital Universitário de Brasília of the Universidade de Brasília (UnB), Brasília, DF.

出版信息

Rev Bras Anestesiol. 2010 May-Jun;60(3):228-36. doi: 10.1016/S0034-7094(10)70031-3.

DOI:10.1016/S0034-7094(10)70031-3

PMID:20682155

Abstract

BACKGROUND AND OBJECTIVES

The beta-2 adrenergic receptor gene has several polymorphisms. Recent studies have demonstrated the clinical importance of the latter. The objective of the present study was to evaluate the influence of the Arg16Gli polymorphism on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid block for Cesarean section.

METHOD

Healthy parturients (ASA I and II) were submitted to subarachnoid anesthesia for elective Cesarean section (n = 50). Ephedrine was administered in cases of arterial hypotension. The incidence of arterial hypotension and the required dose of ephedrine to correct the arterial pressure were compared between the different genotypes identified.

RESULTS

The most prevalent genotype was Arg16Gli (60%, n = 30) followed by Gli16Gli (26%, n = 13) and Arg16Arg (14%, n = 7). No differences were observed regarding the basic characteristics of the genotypes. In comparison to the Arg16Arg genotype, the Gli16Gli presented a 3.95-fold increase in the hazard ratio of arterial hypotension (95%CI 0.86-18.11; p = 0.076), whereas the Arg16Gli presented a 4.83-fold increase (95%CI 1.13-20.50; p = 0.033). The parturients with the Arg16Arg needed, on average, 6.4 +/- 8.5 mg of ephedrine to correct the arterial hypotension, whereas those with the Arg16Gli needed 19.5 +/- 15.9 mg (p = 0.0445; 95%CI 0.3325-25.78) and the ones with the Gli16Gli genotype, 19.2 +/- 14.3 (p = 0.0445, 95%CI 0.3476-25.26).

CONCLUSIONS

The results show that the genetic variant Arg16Arg presents a lower incidence of arterial hypertension and that lower doses of ephedrine were necessary to reestablish normal arterial pressure in the patients with this genetic profile. We conclude that the Arg16Arg genotype confers better pressure stability to the parturients submitted to subarachnoid anesthesia for Cesarean section.

摘要

背景与目的

β-2肾上腺素能受体基因存在多种多态性。近期研究已证实了后者的临床重要性。本研究的目的是评估Arg16Gli多态性对接受剖宫产蛛网膜下腔阻滞的孕妇发生动脉低血压及使用麻黄碱情况的影响。

方法

健康产妇（美国麻醉医师协会分级I级和II级）接受择期剖宫产蛛网膜下腔麻醉（n = 50）。出现动脉低血压时给予麻黄碱。比较不同基因型产妇的动脉低血压发生率及纠正动脉压所需的麻黄碱剂量。

结果

最常见的基因型是Arg16Gli（60%，n = 30），其次是Gli16Gli（26%，n = 13）和Arg16Arg（14%，n = 7）。各基因型的基本特征未见差异。与Arg16Arg基因型相比，Gli16Gli基因型产妇发生动脉低血压的风险比增加3.95倍（95%可信区间0.86 - 18.11；p = 0.076），而Arg16Gli基因型产妇增加4.83倍（95%可信区间1.13 - 20.50；p = 0.033）。Arg16Arg基因型的产妇纠正动脉低血压平均需要6.4±8.5 mg麻黄碱，而Arg16Gli基因型的产妇需要19.5±15.9 mg（p = 0.0445；95%可信区间0.3325 - 25.78），Gli16Gli基因型的产妇需要19.2±14.3 mg（p = 0.0445，95%可信区间0.3476 - 25.26）。