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  本文選題：單核苷酸多態(tài)性　切入點：術后惡心嘔吐　出處：《福建醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：【目的】通過基因多態(tài)性分析，探討影響全麻乳腺手術后惡心嘔吐個體差異的遺傳因素，以期實現(xiàn)依據(jù)基因型個體化抗吐治療。 【方法】納入246例ASA I-II級擇期全麻下行乳腺手術的女性患者，采用統(tǒng)一的全身麻醉方案，收集并記錄患者的年齡、身高、體重、既往暈動病史、PONV史、麻醉時間、術后24小時惡心、嘔吐發(fā)生率及首次出現(xiàn)時間等。將與惡心嘔吐相關的OPRM1、HTR3D、HTR3C、HTR3B和DRD2基因上的7個單核苷酸多態(tài)性（SNPs）位點納入研究并采用iMLDR技術進行基因分型。采用logistic回歸模型、Kaplan-Meier法與Cox回歸模型來分析SNPs對術后惡心或嘔吐的影響。 【結果】患者均順利完成手術及術后隨訪，5名患者因術后預防性使用抗吐藥和1例樣本因可能受到污染而未能成功分型予以剔除，其余240例均獲得成功分型。HTR3D基因SNP（rs6443930）較少等位基因純合子CC患者術后早期（0-6h）發(fā)生惡心和嘔吐的風險分別是GG基因型患者的3.310和3.403倍，而且CC基因型患者術后24h發(fā)生惡心的風險大于GG基因型患者（P=0.047，HR=1.998，95%CI：1.009-3.956）；HTR3C基因SNP（rs6807670）較少等位基因純合子GG患者術后24h發(fā)生惡心的風險與雜合子GA患者術后24h發(fā)生嘔吐的風險均小于AA基因型患者（P=0.022，HR=0.077，95%CI：0.008-0.693與P=0.047，HR=0.482，，95%CI：0.235-0.990）；HTR3B基因SNP（rs1672717）雜合子GA患者發(fā)生術后晚期（6-24h）發(fā)生嘔吐的風險是AA基因型患者的4.146倍。 【結論】 HTR3D基因SNP（rs6443930）、HTR3C基因SNP（rs6807670）和HTR3B基因SNP（rs1672717）與全麻乳腺手術后惡心嘔吐發(fā)生相關，可能是決定術后惡心嘔吐個體遺傳易感性的重要因素。
[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.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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相關期刊論文 前2條

1 張曉靜;張頻;;腫瘤化療所致惡心嘔吐的發(fā)生機制和藥物治療的研究進展[J];癌癥進展;2006年04期

2 張海紅;劉永飛;劉素蘭;劉詩l

本文編號：1610780