BACKGROUND:Emerging evidence has shown that the most common polymorphism (A118G; rs1799971 A>G) in the μ-opioid receptor (OPRM1) gene may influence the response to labor analgesia, but individually published studies showed inconclusive results. OBJECTIVE:This meta-analysis aimed to derive a more precise estimation of the effects of the OPRM1 A118G polymorphism on epidural analgesia with fentanyl during labor. METHODS:A literature search was conducted on PubMed, Embase, Web of Science, and China BioMedicine databases before April 1st, 2013. The crude standardized mean difference (SMD) or odds ratio (OR) with 95% confidence interval (CI) was calculated. RESULTS:Six clinical studies were included with a total 838 women who received epidural analgesia with fentanyl during labor. The meta-analysis results indicated that women carrying the G allele (AG+GG) of the OPRM1 A118G polymorphism required less fentanyl doses to achieve adequate pain relief compared with those with the AA homozygote (SMD=-0.24, 95% CI [-0.44, -0.03], p=0.022). The 118G variant was associated with a decreased ED50 of fentanyl for labor analgesia (SMD=-1.56, 95% CI [-1.97, -1.15], p<0.001). The analgesia satisfaction in women carrying the G allele (AG+GG) was higher than those with the AA homozygote (SMD=0.22, 95% CI [0.05, 0.39], p=0.012). However, there were no statistically significant differences between an AA homozygote and a G carrier (AG+GG) in the incidence of nausea and vomiting (OR=1.99, 95% CI [0.88, 4.52], p=0.101). CONCLUSION:In conclusion, the current meta-analysis indicates that women carrying the G allele (AG+GG) of OPRM1 A118G polymorphism may have a good response to epidural analgesia with fentanyl during labor. The OPRM1 A118G polymorphism may help predict individuals' response to epidural labor analgesia and so optimize postoperative pain control.

译文

背景:新兴证据表明,μ阿片受体(OPRM1)基因中最常见的多态性(A118G; rs1799971 A> G)可能影响对分娩镇痛的反应,但个别发表的研究结果尚无定论。
目的:本荟萃分析旨在更准确地评估OPRM1 A118G基因多态性对芬太尼分娩时硬膜外镇痛的影响。
方法:在2013年4月1日之前在PubMed,Embase,Web of Science和中国生物医学数据库上进行文献检索。计算出具有95%置信区间(CI)的粗标准均差(SMD)或比值比(OR)。 。
结果:共进行了六项临床研究,共有838名在分娩期间接受芬太尼硬膜外镇痛的妇女。荟萃分析结果表明,与AA纯合子相比,携带OPRM1 A118G多态性的G等位基因(AG GG)的女性需要较少的芬太尼剂量才能获得足够的疼痛缓解(SMD = -0.24,95%CI [-0.44, -0.03],p = 0.022)。 118G变体与用于分娩镇痛的芬太尼ED50降低有关(SMD = -1.56,95%CI [-1.97,-1.15],p <0.001)。携带G等位基因(AG GG)的女性的镇痛满意度高于AA纯合子的女性(SMD = 0.22,95%CI [0.05,0.39],p = 0.012)。但是,AA纯合子和G携带者(AG GG)在恶心和呕吐的发生率上没有统计学上的显着差异(OR = 1.99,95%CI [0.88,4.52],p = 0.101)。
结论:总而言之,当前的荟萃分析表明,携带OPRM1 A118G多态性的G等位基因(AG GG)的妇女在分娩时对芬太尼硬膜外镇痛有良好的反应。 OPRM1 A118G基因多态性可以帮助预测个体对硬膜外分娩镇痛的反应,从而优化术后疼痛控制。

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