中国人群基因多态性与全麻乳腺手术后恶心呕吐遗传易感性关联研究

发布时间：2018-03-14 10:20

本文选题：单核苷酸多态性　切入点：术后恶心呕吐　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：【目的】通过基因多态性分析，探讨影响全麻乳腺手术后恶心呕吐个体差异的遗传因素，以期实现依据基因型个体化抗吐治疗。【方法】纳入246例ASA I-II级择期全麻下行乳腺手术的女性患者，采用统一的全身麻醉方案，收集并记录患者的年龄、身高、体重、既往晕动病史、PONV史、麻醉时间、术后24小时恶心、呕吐发生率及首次出现时间等。将与恶心呕吐相关的OPRM1、HTR3D、HTR3C、HTR3B和DRD2基因上的7个单核苷酸多态性（SNPs）位点纳入研究并采用iMLDR技术进行基因分型。采用logistic回归模型、Kaplan-Meier法与Cox回归模型来分析SNPs对术后恶心或呕吐的影响。【结果】患者均顺利完成手术及术后随访，5名患者因术后预防性使用抗吐药和1例样本因可能受到污染而未能成功分型予以剔除，其余240例均获得成功分型。HTR3D基因SNP（rs6443930）较少等位基因纯合子CC患者术后早期（0-6h）发生恶心和呕吐的风险分别是GG基因型患者的3.310和3.403倍，而且CC基因型患者术后24h发生恶心的风险大于GG基因型患者（P=0.047，HR=1.998，95%CI：1.009-3.956）；HTR3C基因SNP（rs6807670）较少等位基因纯合子GG患者术后24h发生恶心的风险与杂合子GA患者术后24h发生呕吐的风险均小于AA基因型患者（P=0.022，HR=0.077，95%CI：0.008-0.693与P=0.047，HR=0.482，，95%CI：0.235-0.990）；HTR3B基因SNP（rs1672717）杂合子GA患者发生术后晚期（6-24h）发生呕吐的风险是AA基因型患者的4.146倍。【结论】 HTR3D基因SNP（rs6443930）、HTR3C基因SNP（rs6807670）和HTR3B基因SNP（rs1672717）与全麻乳腺手术后恶心呕吐发生相关，可能是决定术后恶心呕吐个体遗传易感性的重要因素。
[Abstract]:[objective] to explore the genetic factors influencing individual differences of nausea and vomiting after general anesthesia in mammary gland operation by gene polymorphism analysis, in order to realize individualized antiemesis therapy based on genotype. [methods] A total of 246 female patients undergoing elective general anesthesia under ASA I-II general anesthesia were enrolled. The patients' age, height, weight, past history of motion sickness and anaesthesia time were collected and recorded. 24 hours after surgery, nausea, The incidence of vomiting and the first occurrence time were studied. The seven single nucleotide polymorphisms (SNPs) of OPRM1HTR3DnHTR3DnHTR3B and DRD2 gene were studied and genotyped by iMLDR. The logistic regression model was used to analyze the results of Kaplan-Meier and Cox. Regression model was used to analyze the effect of SNPs on postoperative nausea or vomiting. [results] all patients completed the operation successfully and 5 patients were followed up successfully because of prophylactic use of antiemetic drugs after operation and one sample could not be successfully classified because of possible contamination. The risk of nausea and vomiting in patients with allelic homozygous CC was 3.310 and 3.403 times higher than that in patients with GG genotype, respectively. Moreover, the risk of nausea in CC genotype patients 24 hours after operation was higher than that in patients with GG genotype. The risk of nausea in patients with allelic homozygous GG and vomiting in patients with heterozygous GA at 24 hours after operation were lower than those in patients with GG genotype. The risk of vomiting in heterozygous GA patients was 4.146 times higher than that in AA genotype patients (P < 0.022). The risk of vomiting in patients with heterozygote GA was 4.146 times higher than that in patients with AA genotype (P < 0.022), I. e., 0. 008-0.693 and 0. 482H / 95 CI: 0. 235-0. 990 (SNPR3B gene SNPR3B gene SNPR3B gene, SNPR3B gene, SNPR3B gene, SNPR3B gene, SNPR3B gene, 1672717). [conclusion] HTR3D gene rs6443930) and HTR3B gene SNPrs6807670) are associated with nausea and vomiting after general mammary surgery, which may be an important factor in determining the individual genetic susceptibility of postoperative nausea and vomiting.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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