围手术期疼痛管理的遗传学
Genetics of perioperative pain management.
作者信息
Packiasabapathy Senthil, Horn Nicole, Sadhasivam Senthilkumar
机构信息
Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA.
出版信息
Curr Opin Anaesthesiol. 2018 Dec;31(6):749-755. doi: 10.1097/ACO.0000000000000660.
PURPOSE OF REVIEW
The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives.
RECENT FINDINGS
Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes. Clinical Pharmacogenetics Implementation Consortium has put forth recommendations on CYP2D6 genotype-based opioid selection and dosing. The list of drug-gene pairs studied continue to expand.
SUMMARY
Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings.
综述目的
本综述将讨论当前关于疼痛与镇痛遗传学的文献，特别关注围手术期情况。我们还将讨论基于药物遗传学的管理指南、当前临床现状及未来展望。
最新发现
近期文献表明，个体间疼痛及术后镇痛反应的差异至少部分归因于个体的基因组成。儿茶酚-O-甲基转移酶、CYP2D6和μ-阿片受体（OPRM1）、ATP结合盒转运体B家族成员1（ABCC3）、有机阳离子转运体1基因中描述了一些与手术疼痛及阿片类药物相关术后不良结局相关的特征明确的多态性。临床药物遗传学实施联盟已就基于CYP2D6基因型的阿片类药物选择和剂量提出建议。所研究的药物-基因对列表持续增加。
总结
药物遗传学方法标志着围手术期和慢性疼痛领域个性化疼痛医学的开端。
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