Klinik für Anästhesiologie & Intensivmedizin, University of Duisburg-Essen and Universitätsklinikum Essen, Essen, Germany.
Klinik für Anästhesiologie & Intensivmedizin, University of Duisburg-Essen and Universitätsklinikum Essen, Essen, Germany.
Br J Anaesth. 2018 Jul;121(1):58-65. doi: 10.1016/j.bja.2018.02.025. Epub 2018 Apr 4.
Clinical risk factors for postoperative nausea and vomiting (PONV) are evaluated with the Apfel score, however patients with low Apfel scores still experience PONV suggesting a genetic predisposition. PONV risk associates with specific M3 muscarinic acetylcholine receptor (CHRM3) rs 2165870 polymorphism. We investigated whether the Apfel score and this genetic variation independently contribute to PONV risk and whether prophylaxis reduces PONV in patients with low Apfel score but at high genetic risk.
In a prospective, controlled study, 454 subjects undergoing elective surgery were genotyped for rs2165870 and its association with PONV was investigated with log-binomial regression analysis. Subjects were randomised to receive acustimulation/dexamethasone, acustimulation/vehicle, sham acustimulation/dexamethasone, or sham acustimulation/vehicle to investigate their effects on PONV risk.
Early PONV occurred in 37% of subjects. The rs2165870 genotype distribution was GG in 191, GA in 207, and AA in 56 subjects. The CHRM3 polymorphism was associated with a relative risk (RR) of 1.5 for GA vs GG [95% confidence interval (CI): 1.1-1.9; P=0.003] and 1.6 for AA vs GG (95% CI: 1.1-2.2; P=0.009) genotypes to develop PONV, and this was independent from the Apfel score (RR per Apfel point: 1.3, 95% CI: 1.2-1.5; P<0.0001). While dexamethasone and acustimulation each reduced the PONV risk by 30% in AA genotype carriers with low Apfel score, combined therapy reduced the risk by 86% (P=0.015).
The CHRM3 polymorphism and the Apfel score independently predict PONV susceptibility. Dexamethasone/acustimulation should be considered in patients with low Apfel score but at high genetic risk.
DRKS00005664.
临床术后恶心呕吐（PONV）的风险因素通过阿佩尔评分（Apfel score）进行评估，但评分低的患者仍会发生 PONV，这表明存在遗传易感性。PONV 风险与特定的 M3 毒蕈碱乙酰胆碱受体（CHRM3）rs2165870 多态性相关。我们研究了阿佩尔评分和这种遗传变异是否独立地导致 PONV 风险，以及在阿佩尔评分低但遗传风险高的患者中，预防是否能降低 PONV。
在一项前瞻性、对照研究中，对 454 名接受择期手术的患者进行 rs2165870 基因分型，并通过二项式回归分析研究其与 PONV 的关系。患者被随机分为接受声刺激/地塞米松、声刺激/载体、假声刺激/地塞米松或假声刺激/载体组，以研究它们对 PONV 风险的影响。
早期 PONV 发生在 37%的患者中。rs2165870 基因型分布为 GG 191 例、GA 207 例、AA 56 例。CHRM3 多态性与 GA 与 GG 相比的相对风险（RR）为 1.5（95%置信区间[CI]：1.1-1.9；P=0.003），与 AA 与 GG 相比的 RR 为 1.6（95%CI：1.1-2.2；P=0.009），表明发生 PONV 的风险增加，且这种相关性独立于阿佩尔评分（每增加一个阿佩尔评分点的 RR：1.3，95%CI：1.2-1.5；P<0.0001）。虽然地塞米松和声刺激在阿佩尔评分低但 AA 基因型携带者中分别降低 30%的 PONV 风险，但联合治疗可降低 86%的风险（P=0.015）。
CHRM3 多态性和阿佩尔评分独立预测 PONV 易感性。在阿佩尔评分低但遗传风险高的患者中，应考虑地塞米松/声刺激。
DRKS00005664。
