Zhao Jinsong, Cai Shihong, Zhang Long, Rao Yuefeng, Kang Xianhui, Feng Zhiying
Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, China.
Pain Ther. 2022 Jun;11(2):395-409. doi: 10.1007/s40122-022-00374-0. Epub 2022 Apr 16.
The abuse of opioids has become one of the most serious concerns in the world. Opioid use can cause serious adverse reactions, including respiratory depression, postoperative nausea and vomiting, itching, and even death. These adverse reactions are also important complications of clinical application of opioid drugs that may affect patient safety and recovery. Due to the fear of adverse reactions of opioids, clinicians often do not dare to use opioids in an adequate or appropriate amount, thus affecting the clinical medication strategy and the quality of treatment for patients. The prediction of adverse reactions to opioids is one of the most concerned problems in clinical practice. At present, the correlation between gene polymorphism and the efficacy of opiates has been widely studied and preliminarily confirmed, but the research on the effect of gene polymorphism on the adverse reactions of opiates is relatively limited. Existing studies have made encouraging progress in predicting the incidence and severity of adverse opioid reactions and clinical management by using genetic testing, but most of these studies are single-center, small-sample clinical studies or animal experiments, which have strong limitations. When the same receptor or enzyme is studied by different experimental methods, different or even opposite conclusions can be drawn. These phenomena indicate that the correlation between gene polymorphism and adverse opioid reaction still needs further research and demonstration. At present, it is still too early to use genetic testing to predict opioid adverse reactions in clinic. In this paper, the correlation between gene polymorphism and adverse opioid reactions and a small number of clinical applications were reviewed in terms of pharmacokinetics and pharmacodynamics, in order to provide some suggestions for future research and clinical drug decision making.
阿片类药物的滥用已成为全球最严重的问题之一。使用阿片类药物会引发严重的不良反应，包括呼吸抑制、术后恶心呕吐、瘙痒，甚至死亡。这些不良反应也是阿片类药物临床应用中的重要并发症，可能影响患者的安全与康复。由于担心阿片类药物的不良反应，临床医生往往不敢足量或合理使用阿片类药物，从而影响临床用药策略及患者的治疗质量。阿片类药物不良反应的预测是临床实践中最受关注的问题之一。目前，基因多态性与阿片类药物疗效之间的相关性已得到广泛研究并初步证实，但基因多态性对阿片类药物不良反应影响的研究相对有限。现有研究在通过基因检测预测阿片类药物不良反应的发生率和严重程度以及临床管理方面取得了令人鼓舞的进展，但这些研究大多是单中心、小样本的临床研究或动物实验，存在很大局限性。当用不同实验方法研究同一受体或酶时，可能得出不同甚至相反的结论。这些现象表明，基因多态性与阿片类药物不良反应之间的相关性仍需进一步研究和论证。目前，在临床上使用基因检测来预测阿片类药物不良反应还为时过早。本文从药代动力学和药效学方面综述了基因多态性与阿片类药物不良反应之间的相关性以及少量临床应用情况，以期为未来研究及临床药物决策提供一些建议。
