Sabrie Marie, Cannas Giovanna, Tazarourte Karim, Poutrel Solène, Connes Philippe, Hot Arnaud, Renoux Céline, Fattoum Jihane, Joly Philippe
a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France.
b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France.
Hemoglobin. 2018 Jul;42(4):217-224. doi: 10.1080/03630269.2018.1529602. Epub 2019 Jan 3.
The aim of this study was to evaluate the clinical, biological and genetic factors that could be associated with the use and dose of morphine during hospitalization for vaso-occlussive crisis (VOC) in adults with sickle cell disease. Ninety-nine hospitalizations for acute VOC (58 sickle cell disease patients aged 18 to 60 years, one to six hospitalizations each) were recorded; we investigated the associations between qualitative and quantitative opioid requirements and several biological, clinical, epidemiological and genetic parameters. Visual analog pain scale (VAS) was the only independent predictor of the qualitative need for morphine (mean value of 8.5 vs. 6.1 for the 77 hospitalizations that required morphine). A higher total administered morphine dose, which relates mainly to the overall crisis severity, was associated with a lower hemoglobin (Hb) level at entry. The mean daily morphine dose, which is more influenced by the individual sensitivity to morphine, was not influenced by the studied genetic parameters [sickle cell disease type, α-thalassemia (α-thal) status, UGT2B7 and ABCB1 genotypes] but a very slight negative association was found with the total bilirubin (BIL) level at entry. Our study demonstrated that physicians are often reluctant to prescribe morphine in sickle cell disease as a VAS of 6 corresponds to the usual threshold of administration in other instances. Total Hb at entry was also associated for the first time with higher total morphine consumption and could be used in a predictive VOC severity score. These results have to be confirmed and completed on larger cohorts.
本研究的目的是评估与镰状细胞病成年患者血管闭塞性危象（VOC）住院期间吗啡使用及剂量可能相关的临床、生物学和遗传因素。记录了99例急性VOC住院病例（58例年龄在18至60岁的镰状细胞病患者，每人住院1至6次）；我们调查了定性和定量阿片类药物需求与几个生物学、临床、流行病学和遗传参数之间的关联。视觉模拟疼痛量表（VAS）是吗啡定性需求的唯一独立预测因素（在77例需要吗啡的住院病例中，平均值为8.5，而不需要吗啡的住院病例为6.1）。较高的吗啡总给药剂量主要与整体危象严重程度相关，与入院时较低的血红蛋白（Hb）水平有关。平均每日吗啡剂量受个体对吗啡敏感性的影响更大，不受所研究的遗传参数[镰状细胞病类型、α地中海贫血（α-thal）状态、UGT2B7和ABCB1基因型]影响，但与入院时的总胆红素（BIL）水平存在非常轻微的负相关。我们的研究表明，在镰状细胞病中，医生通常不愿意开具吗啡，因为VAS为6相当于其他情况下通常的给药阈值。入院时的总Hb水平也首次与更高的吗啡总消耗量相关，可用于预测VOC严重程度评分。这些结果必须在更大的队列中得到证实和完善。
