Department of Medicine, Royal Marsden NHS Foundation Trust, London, UK.
Clin Genet. 2012 Oct;82(4):301-10. doi: 10.1111/j.1399-0004.2012.01923.x. Epub 2012 Jul 27.
There are now several strong opioids available to choose from for the relief of moderate to severe pain. On a population level, there is no difference in terms of analgesic efficacy or adverse reactions between these drugs; however, on an individual level there is marked variation in response to a given opioid. The genetic influences to this variation are complex, and although current research has shown some promising results, these have not been replicated across larger studies and as such the ultimate aim of personalized prescribing remains elusive. If personalized prescribing could be achieved this would have a major impact at an individual level to facilitate safe, effective and rapid symptom control. This review presents some of the recent positive advances in opioid pharmacogenetic studies, focusing on associations between candidate genes and the three main elements of opioid response: analgesic, upper gastrointestinal and central adverse reactions.
目前有几种强效阿片类药物可供选择，用于缓解中度至重度疼痛。在人群水平上，这些药物在镇痛效果或不良反应方面没有差异；然而，在个体水平上，对特定阿片类药物的反应存在显著差异。这种变异的遗传影响很复杂，尽管目前的研究已经显示出一些有希望的结果，但这些结果并没有在更大的研究中得到复制，因此个体化处方的最终目标仍然难以实现。如果能够实现个体化处方，将对个人层面产生重大影响，有助于安全、有效和快速地控制症状。本文综述了阿片类药物药物遗传学研究的一些最新进展，重点关注候选基因与阿片类药物反应的三个主要因素之间的关联：镇痛、上消化道和中枢不良反应。
