CAJ | 학술논문

目的探讨COMTval158met基因多态性对患者术前焦虑和疼痛敏感性的影响.方法择期手术患者284例,性别不限,年龄20～ 50岁,体重指数在正常范围,ASA分级Ⅰ或Ⅱ级；另取健康志愿者28名,年龄18 ～ 25岁,体重指数在正常范围.采用苯酚-氯仿萃取法提取DNA.采用聚合酶链式反应-限制性片段长度多态性法进行COMTval158met基因多态性检测.根据患者和健康志愿者基因型分组:野生型纯合子组(G/G组)、突变型杂合子组(G/A组)和突变型纯合子组(A/A组).手术或试验前1d进行焦虑状态评分(SAI评分)和焦虑特质评分(TAI评分)；患者或健康志愿者入室后平静10 min,采用电刺激仪测定痛阈与耐痛阈.结果患者G/G组132例,G/A组110例,A/A组42例.健康志愿者G/G组12名,G/A组11名,A/A组5名.COMTval158met等位基因A突变频率为34.5％.健康志愿者3个基因组痛阈、耐痛阈、SAI评分和TAI评分比较差异无统计学意义(P＞0.05)；与G/G组比较,患者A/A组痛阈、耐痛阈降低,SAI评分和TAI评分升高(P＜0.05),G/A组上述指标差异无统计学意义(P＞0.05)；与健康志愿者比较,患者G/G组和G/A组SAI评分升高,A/A组痛阈、耐痛阈降低,SAI评分升高(P＜0.05).患者COMTval158met等位基因A与耐痛阈、痛阈呈负相关,与术前SAI评分呈正相关(P＜0.05).结论 COMT val158 met基因多态性与患者术前焦虑程度显著相关,以致引起患者疼痛敏感性增强.
목적 탐토COMTval158met기인다태성대환자술전초필화동통민감성적영향.방법 택기수술환자284례,성별불한,년령20～ 50세,체중지수재정상범위,ASA분급Ⅰ혹Ⅱ급；령취건강지원자28명,년령18 ～ 25세,체중지수재정상범위.채용분분-록방췌취법제취DNA.채용취합매련식반응-한제성편단장도다태성법진행COMTval158met기인다태성검측.근거환자화건강지원자기인형분조:야생형순합자조(G/G조)、돌변형잡합자조(G/A조)화돌변형순합자조(A/A조).수술혹시험전1d진행초필상태평분(SAI평분)화초필특질평분(TAI평분)；환자혹건강지원자입실후평정10 min,채용전자격의측정통역여내통역.결과 환자G/G조132례,G/A조110례,A/A조42례.건강지원자G/G조12명,G/A조11명,A/A조5명.COMTval158met등위기인A돌변빈솔위34.5％.건강지원자3개기인조통역、내통역、SAI평분화TAI평분비교차이무통계학의의(P＞0.05)；여G/G조비교,환자A/A조통역、내통역강저,SAI평분화TAI평분승고(P＜0.05),G/A조상술지표차이무통계학의의(P＞0.05)；여건강지원자비교,환자G/G조화G/A조SAI평분승고,A/A조통역、내통역강저,SAI평분승고(P＜0.05).환자COMTval158met등위기인A여내통역、통역정부상관,여술전SAI평분정정상관(P＜0.05).결론 COMT val158 met기인다태성여환자술전초필정도현저상관,이치인기환자동통민감성증강.
Objective To investigate the effects of catechol-O-methyltransferase (COMT) val158met genetic polymorphism on preoperative anxiety and pain sensitivity in patients.Methods Two hundred and eighty-four ASA Ⅰ or Ⅱ patients,aged 20-50 yr,with the body mass index within the normal range,undergoing elective operation and another 28 healthy volunteers,aged 18-25 yr,with the body mass index within the normal range,were enrolled in this study.Blood samples were taken from the peripheral vein for DNA extraction and COMTval158met genotyping using phenol chloroform extracting method and polymerase chain reaction-restriction fragment length polymorphism,respectively.The patients and healthy volunteers were assigned into 3 groups according to their genotypes:wild-type homozygotes (group G/G),mutation hetorozygote (group G/A) and mutation homozygote group (group A/A).Anxiety was measured with State-Trait Anxiety Inventory (SAI/TAI) 1 day before operation or test.The pain threshold (PT) and pain tolerance threshold (PTT) in the participating subjects were measured by electric stimulation using a stimulator 10 min after admission to the operating room.Results There were 132 G/G,110 G/A and 42 A/A among 284 patients,while 12 G/G,11 G/A and 5 A/A among 28 healthy volunteers.The COMTval158met A allele frequency was 34.5％.There was no significant difference in the PT,PTT,SAI scores and TAI scores between the three groups of healthy volunteers (P ＞ 0.05).Compared with G/G group,the PT and PTT were significantly decreased and SAI and TAI scores were increased in group A/A of patients (P ＜ 0.05).Compared with healthy volunteers,SAI scores were significantly increased in G/G and G/A groups of patients,and the PT and PTT were decreased and SAI scores were significantly increased in A/A group of patients (P ＜ 0.05).The COMTval158met A allele was negatively correlated with the PT and PTT and positively correlated with SAI scores in patients (P ＜ 0.05).Conclusion COMTvall58met genetic polymorphism is significantly correlated with preoperative anxiety,thus resulting in increased pain sensitivity in patients.