中文摘要：

目的 评价COMTval15 met和OPRM1A118G基因多态性对患者术前疼痛敏感性的影响.方法 择期妇科或普外科手术患者,无手术史,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.于术前采集外周静脉血样5 ml,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和OPRM1A118G基因多态性检测.根据患者基因型联合分组,共分9组：val/val和A/A组（A1B1组）、val/met和A/A组（A2B1组）、met/met和A/A组（A3B1组）、val/val和A/G组（A1B2组）、val/met和A/G组（A2B2组）、met/met和A/G组（A3B2组）、val/val和G/G组（A1B3组）、val/met和G/G组（A2B3组）以及met/met和G/G组（A3B3组）.入手术室后,采用电刺激仪测定患者痛阈和耐痛阈.结果 联合基因分型成功277例,A1B1组68例,A2B1组50例,A3B1组17例,A1B2组43例,A2B2组46例,A3B2组17例,A1B3组18例,A2B3组10例,A3B3组8例.各组患者一般情况各指标的比较差异无统计学意义（P＞0.05）.OPRM1A118G和COMTval158met等位基因在国内人群中的突变率分别为32.1％和34.3％.与A1B1组比较,A2B3组和A3 B3组痛阈降低,A1B3组、A2B3组和A3B3组耐痛阈降低（P＜0.05）.结论 COMTval158met和OPRM1A118G基因多态性对患者术前疼痛敏感性的影响存在交互作用.携带COMT和OPRM1基因双突变型纯合子met158met和118G的患者术前疼痛敏感性更高.

英文摘要：

Objective To evaluate the effects of COMTval158met and OPRM1A118G genetic polymorphism on preoperative pain sensitivity in patients.Methods ASA physical status Ⅰ or Ⅱ patients of both sexes,with no history of surgery,aged 20-50 yr,with the body mass index within the normal range,scheduled for elective gynecological or general surgery,were enrolled in the study.Blood samples were taken from the peripheral vein for DNA extraction and COMTval158met and OPRM1A118G genotyping using phenol chloroform extracting method and polymerase chain reaction-restriction fragment length polymorphism,respectively.The patients were divided into 9 groups according to combination of their genotypes：group val/val and A/A （group A1B1）,group val/met and A/ A （group A2B1）,group met/met and A/A （group A3B1）,group val/val and A/G （group A1B2）,group val/ met and A/G （group A2B2）,group met/met and A/G （group A3B2）,group val/val and G/G （group A1B3）,group val/met and G/G （group A2B3） and group met/met and G/G （group A3B3）.The pain threshold and pain tolerance threshold were measured three times using electrical stimulation after admission to the operating room and the average was calculated.Results Two hundred and seventy-seven subjects were genotyped successfully.There were 68 A1B1,50 A2B1,17A3B1,43 A1B2,46 A2B2,17 A3B2,18 A1B3,10 A2B3 and 8 A3B3.There was no significant difference in the general data of patients among the nine groups （P ＞ 0.05）.The OPRM1A118G and COMTval158met allele frequency in Chinese was 0.321 and 0.343,respectively.Compared with group A1B1,the pain threshold was significantly decreased in A2B3 and A3B3 groups,and the pain tolerance threshold was decreased in A1B1,A2B3 and A3B3 groups （P ＜ 0.05）.Conclusion There is interaction between COMTval158met and OPRM1A118G genetic polymorphism in their effects on preoperative pain sensitivity and preoperative pain sensitivity is higher in the patients who carry mutation homozygote met158met and 118G.