Department of Anesthesiology, Qianfoshan Hospital Affiliated to Medical College of Shandong University, Jinan, China.
Department of Anesthesiology, Zibo Center Hospital, Zibo, China.
Acta Anaesthesiol Scand. 2018 Nov;62(10):1367-1373. doi: 10.1111/aas.13178. Epub 2018 Jun 21.
Pain is one of the major adverse clinical outcomes of cesarean section (CS). In the past few years, researchers and physicians have been optimizing post-operative analgesic modalities, but the results are still undesirable for the parturient. The cytochrome P-450 3A4 (CYP3A4) gene has been reported to contribute significantly to human liver microsomal oxidation of sufentanil and alfentanil.
We detected the frequency of CYP3A4 mutant allele, which is associated with the metabolism of diverse drugs, including opioids used for anesthesia. We then investigated the correlation between sufentanil (an opioid analgesic) consumption and CYP3A4 genetic polymorphism.
We found the frequency of the CYP3A4∗1G (the mutant form of CYP3A) variant allele to be 0.279 in 71 parturients undergoing cesarean section and 137 age-matched parturients with vaginal delivery. Interestingly, the parturients with homozygous CYP3A4∗1G showed less sufentanil consumption compared with those having the wild-type genotype.
In summary, we found a correlation between CYP3A4 genetic polymorphism and sufentanil consumption. This might be helpful for optimizing the anesthesia strategies and reducing their side effects.
疼痛是剖宫产（CS）的主要不良临床结局之一。在过去的几年中，研究人员和医生一直在优化术后镇痛方式，但结果仍不能令人满意。细胞色素 P-450 3A4（CYP3A4）基因已被报道对舒芬太尼和阿芬太尼的人肝微粒体氧化有重要贡献。
我们检测了与包括用于麻醉的阿片类药物在内的多种药物代谢相关的 CYP3A4 突变等位基因的频率。然后，我们研究了舒芬太尼（一种阿片类镇痛药）消耗与 CYP3A4 遗传多态性之间的相关性。
我们发现，71 例剖宫产和 137 例年龄匹配的阴道分娩产妇中，CYP3A4∗1G（CYP3A 的突变形式）变体等位基因的频率为 0.279。有趣的是，与具有野生型基因型的产妇相比，纯合 CYP3A4∗1G 的产妇舒芬太尼消耗较少。
总之，我们发现 CYP3A4 遗传多态性与舒芬太尼消耗之间存在相关性。这可能有助于优化麻醉策略并减少其副作用。
