中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2013年
16期
997-1000
,共4页
郑宇欣(综述)%于泳浩(审校)
鄭宇訢(綜述)%于泳浩(審校)
정우흔(종술)%우영호(심교)
药物耐受%吗啡%痛觉过敏%降钙素基因相关肽
藥物耐受%嗎啡%痛覺過敏%降鈣素基因相關肽
약물내수%마배%통각과민%강개소기인상관태
drug tolerance%morphine%hyperalgesia%calcitonin gene-related peptide (CGRP)
疼痛是晚期恶性肿瘤患者的常见症状，是影响患者生存质量的主要因素，阿片类药物吗啡是治疗急慢性疼痛的常用药物，但长时间应用会导致吗啡耐受及其相关痛觉过敏现象的发生，制约其临床应用。本文总结分析近年相关文献，从伤害性感受角度探讨慢性吗啡耐受及其相关痛觉过敏的形成原因，重点阐述降钙素基因相关肽（calcitonin gene-related peptide，CGRP）在其中的作用，从CGRP的分子生物学特征与分布、长期吗啡应用与CGRP的关系、CGRP与痛觉过敏等方面详细分析了慢性吗啡给药所致的神经系统可塑性变化与CGRP表达上调之间的关系，并对CGRP表达上调对机体伤害性感受系统的影响进行分析，阐述了CGRP表达上调与痛觉过敏形成之间的关系。从机制上论述了CGRP表达上调所致的伤害性感受增强对吗啡耐受及其相关痛觉过敏的促进作用，为治疗吗啡耐受和进一步研究吗啡耐受机理提供了一个靶点和思路。
疼痛是晚期噁性腫瘤患者的常見癥狀，是影響患者生存質量的主要因素，阿片類藥物嗎啡是治療急慢性疼痛的常用藥物，但長時間應用會導緻嗎啡耐受及其相關痛覺過敏現象的髮生，製約其臨床應用。本文總結分析近年相關文獻，從傷害性感受角度探討慢性嗎啡耐受及其相關痛覺過敏的形成原因，重點闡述降鈣素基因相關肽（calcitonin gene-related peptide，CGRP）在其中的作用，從CGRP的分子生物學特徵與分佈、長期嗎啡應用與CGRP的關繫、CGRP與痛覺過敏等方麵詳細分析瞭慢性嗎啡給藥所緻的神經繫統可塑性變化與CGRP錶達上調之間的關繫，併對CGRP錶達上調對機體傷害性感受繫統的影響進行分析，闡述瞭CGRP錶達上調與痛覺過敏形成之間的關繫。從機製上論述瞭CGRP錶達上調所緻的傷害性感受增彊對嗎啡耐受及其相關痛覺過敏的促進作用，為治療嗎啡耐受和進一步研究嗎啡耐受機理提供瞭一箇靶點和思路。
동통시만기악성종류환자적상견증상，시영향환자생존질량적주요인소，아편류약물마배시치료급만성동통적상용약물，단장시간응용회도치마배내수급기상관통각과민현상적발생，제약기림상응용。본문총결분석근년상관문헌，종상해성감수각도탐토만성마배내수급기상관통각과민적형성원인，중점천술강개소기인상관태（calcitonin gene-related peptide，CGRP）재기중적작용，종CGRP적분자생물학특정여분포、장기마배응용여CGRP적관계、CGRP여통각과민등방면상세분석료만성마배급약소치적신경계통가소성변화여CGRP표체상조지간적관계，병대CGRP표체상조대궤체상해성감수계통적영향진행분석，천술료CGRP표체상조여통각과민형성지간적관계。종궤제상논술료CGRP표체상조소치적상해성감수증강대마배내수급기상관통각과민적촉진작용，위치료마배내수화진일보연구마배내수궤리제공료일개파점화사로。
Pain is a common symptom in patients with terminal cancer and is the main factor that affects their quality of life. Morphine is commonly used for the treatment of acute and chronic pain, but the long-time application of morphine results in morphine tolerance and hyperalgesia, which restrict the clinical applications of the anesthetic. In this review, pertinent studies on morphine over recent years were summarized and analyzed, and the mechanism of morphine tolerance and hyperalgesia were discussed, specifically on the function of calcitonin gene-related peptide (CGRP) in clinical practice. The authors analyzed the relationship between the plastic changes in the nervous system and chronic morphine application in terms of CGRP up-regulation based on its molecular biology charac-teristics and distribution, the relationship between CGRP and chronic application of morphine, and between CGRP and hyperalgesia. The effect of CGRP up-regulation on the nociceptive system and the relationship between CGRP up-regulation and the formation of hy-peralgesia were also analyzed. We discussed the sensitized effect of CGRP up-regulation on the nociceptive system, which promotes morphine tolerance and hyperalgesia. This study provides a framework for treating morphine tolerance and can be used as a guide for further research on the topic.
