Department of Anesthesiology, Qingdao University, Qingdao, China.
Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, China.
Pain Physician. 2019 Jul;22(4):331-340.
There is obvious difference in individual response to opioids. Many studies have examined the correlation between the mu-opioid receptor 1 (OPRM1) 118A>G genetic variation and opioid requirement in pain treatment, but the conclusion remains elusive.
To investigate whether the OPRM1 118A>G genetic variation is associated with the opioid requirement.
Systematic review and meta-analysis.
PubMed, Cochrane library, and EMBASE databases were systematically searched up to May 5, 2018, using the keywords "OPRM1," "genetic variant," "opioid," and "pain" to identify reviews or meta-analyses on this topic. Two independent reviewers performed the data extraction and assessed study quality. The authors investigated the standardized mean difference (SMD) of opioid requirement between AA homozygotes and G allele carriers. The authors also examined the association between the OPRM1 118A>G genetic variation and adverse effects such as nausea and vomiting. Potential bias was assessed using the Egger's test and the Begg's test.
A total of 530 articles were retrieved from the databases searched, and 36 studies involving 8,609 patients were included in the final analysis. G allele carriers required a higher mean opioid dose (SMD: 0.17; 95% confidence interval [CI]: [0.12, 0.22]; P < 0.001) and displayed less nausea risk difference (RD): -0.04; 95% CI: [-0.06, -0.01]), but the incident rate of vomiting has no relationship with the genetic variant than AA homozygotes in a random-effects meta-analysis. Although there was no evidence of publication bias (Begg's test: P = 0.333; Egger's: P = 0.561), heterogeneity was present among studies (I-squared = 54.3%). In the subgroup meta-analyses, there was also significance observed in the postoperative pain setting.
In all of the articles reviewed, postoperative pain and cancer pain were mostly discussed except for one in other pain setting.
In this meta-analysis, the results indicate the OPRM1 A118G polymorphism was associated with the opioid requirement and the adverse effects in pain treatment especially in postoperative pain. This may provide valuable information for clinicians to adopt personalized pain management by properly using the opioids in individual patients.
OPRM1, genetic variation, opioid, pain, side effect, review, meta-analysis.
个体对阿片类药物的反应存在明显差异。许多研究已经探讨了μ-阿片受体 1（OPRM1）118A>G 遗传变异与疼痛治疗中阿片类药物需求之间的相关性，但结论仍不确定。
探讨 OPRM1 118A>G 遗传变异是否与阿片类药物需求相关。
系统评价和荟萃分析。
系统检索 PubMed、Cochrane 图书馆和 EMBASE 数据库，检索关键词包括“OPRM1”、“遗传变异”、“阿片类药物”和“疼痛”，以确定该主题的综述或荟萃分析。两位独立的审稿人提取数据并评估研究质量。作者分析了 AA 纯合子和 G 等位基因携带者之间阿片类药物需求的标准化均数差值（SMD）。作者还研究了 OPRM1 118A>G 遗传变异与恶心和呕吐等不良反应之间的关系。使用 Egger 检验和 Begg 检验评估潜在偏倚。
从检索的数据库中总共检索到 530 篇文章，最终有 36 项研究纳入了 8609 名患者。G 等位基因携带者需要更高的平均阿片类药物剂量（SMD：0.17；95%置信区间[CI]：[0.12，0.22]；P<0.001），恶心的风险差异更小（RD：-0.04；95%CI：[-0.06，-0.01]），但呕吐的发生率与 AA 纯合子无差异。尽管没有发现发表偏倚（Begg 检验：P=0.333；Egger 检验：P=0.561），但研究之间存在异质性（I-squared=54.3%）。在亚组荟萃分析中，在术后疼痛环境中也观察到了显著差异。
在所有综述的文章中，除了一篇在其他疼痛环境下的文章外，大多数都讨论了术后疼痛和癌症疼痛。
在这项荟萃分析中，结果表明 OPRM1 A118G 多态性与疼痛治疗中的阿片类药物需求和不良反应相关，尤其是在术后疼痛中。这可能为临床医生提供有价值的信息，以便通过在个体患者中适当使用阿片类药物来采用个性化的疼痛管理。
OPRM1、遗传变异、阿片类药物、疼痛、副作用、综述、荟萃分析。
