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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (1): 74-80.doi: 10.3969/j.issn.1674-5671.2025.01.10

• 临床研究 • 上一篇    下一篇

盐酸羟考酮缓释片治疗重度癌痛的起始滴定剂量及基因多态性研究

  

  1. 广西壮族自治区人民医院肿瘤内科一区；广西壮族自治区人民医院老年内分泌代谢科；广西壮族自治区人民医院广西医学科学院科研合作部
  • 出版日期:2025-02-25 发布日期:2025-03-06
  • 通讯作者: 谢嫣嫣 E-mail：7363458@qq.com
  • 基金资助:
    广西医疗卫生适宜技术开发与推广应用项目（S2020072）；广西重点研发计划项目（桂科AB21196012）

Study on the initial titration dose and genetic polymorphism of oxycodone hydrochloride prolonged-release tablets in the treatment of severe cancer pain

  • Online:2025-02-25 Published:2025-03-06

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摘要： 目的 探讨重度癌痛患者应用10 mg和20 mg盐酸羟考酮缓释片作为起始滴定剂量的镇痛效果差异，以及OPRM1 A118G和ABCB1 C3435T基因多态性与盐酸羟考酮缓释片需求量之间的关系。方法 选择2019年1月至2020年10月在广西壮族自治区人民医院肿瘤内科初治的既往未系统使用过阿片类药物的重度癌痛患者148例，将其随机分为试验组和对照组，各74例，分别以20 mg、10 mg盐酸羟考酮缓释片作为起始滴定剂量。记录两组患者的疼痛缓解率、3 d内疼痛滴定完成率、盐酸羟考酮缓释片需求量及不良反应，并计算不同基因型患者盐酸羟考酮缓释片的需求量。结果 试验组患者1 h、24 h疼痛缓解率及3 d内疼痛滴定完成率明显高于对照组（90.5% vs 68.9%，P=0.001；89.2% vs 75.7%，P=0.031；70.3% vs 54.1%，P=0.040）。癌痛滴定稳定后，两组患者24 h⁃盐酸羟考酮缓释片用量和最常见不良反应差异均无统计学意义（均P>0.05）。试验组和对照组患者的中位24 h⁃盐酸羟考酮缓释片用量分别为54.62（35.18，105.82）mg和62.15（42.69，102.79）mg，其中恶心呕吐、便秘和头晕是最常见的不良反应，经过对症处理后均能够缓解。携带OPRM1 A118G位点AA、AG、GG基因型的患者24 h⁃盐酸羟考酮缓释片需求量存在差异（P<0.05），其中携带GG基因型的患者需求量最高，而ABCB1 C34357基因多态性对重度癌痛患者盐酸羟考酮缓释片用量无明显影响。结论 使用20 mg盐酸羟考酮缓释片作为起始滴定剂量可提高重度癌痛的缓解率且安全性良好。OPRM1 A118G基因多态性可能影响盐酸羟考酮缓释片的需求量，其可能成为指导癌痛治疗的潜在生物标志物。

关键词: 重度癌痛, 盐酸羟考酮缓释片, 基因多态性, 镇痛, 起始滴定剂量

Abstract: Objective To investigate the analgesic effect of 10 mg and 20 mg oxycodone hydrochloride prolonged⁃release tablets as initial titration doses in patients with severe cancer pain, and the relationship between genetic polymorphisms of OPRM1 A118G and ABCB1 C3435T and the requirement for oxycodone hydrochloride prolonged⁃release tablets. Methods A total of 148 patients with severe cancer pain, who had not previously used opioids systematically and were initially treated at the Department of Medical Oncology of the People's Hospital of Guangxi Zhuang Autonomous region between January 2019 and October 2020 were selected, and randomly divided into the experimental group and the control group, with 74 patients each, using 20 mg and 10 mg oxycodone hydrochloride prolonged⁃release tablets as the initial titration dose. The pain relief rate, the completion rate of pain titration within 3 d, the requirement for oxycodone hydrochloride prolonged⁃release tablets, and adverse reactions in both groups were recorded. The requirement for oxycodone hydrochloride prolonged⁃release tablets under different genotypes was calculated. Results The pain relief rates at 1 hour and 24 hours, as well as the completion rate of pain titration within 3 days in the experimental group were significantly higher than those in the control group（90.5% vs 68.9%, P=0.001; 89.2% vs 75.7%, P=0.031; 70.3% vs 54.1%, P=0.040）. After the titration of cancer pain was stabilized, there was no statistical significance in the 24 h requirement of oxycodone hydrochloride prolonged⁃release tablets and common adverse reactions in both groups (all P>0.05). The median 24 h requirement of oxycodone hydrochloride prolonged⁃release tablets in the experimental group and the control groups were 54.62 (35.18, 105.82) mg and 62.15 (42.69, 102.79) mg, respectively. Nausea and vomiting, constipation, and dizziness were the most common adverse reactions, all of which could be alleviated with symptomatic treatment. Patients carrying AA, AG, and GG genotypes at the OPRM1 A118G site exhibited different requirements for 24 h oxycodone hydrochloride prolonged⁃release tablets (P<0.05), among which the patients carrying the GG genotype having the highest demand , while the genetic polymorphisms of ABCB1 C3435T had no significant effect on the requirement of oxycodone hydrochloride prolonged⁃release tablets in patients with severe cancer pain. Conclusions Using 20 mg oxycodone hydrochloride prolonged⁃release tablets as the initial titration dose can improve the remission rate of severe cancer pain and ensures greater safety. The OPRM1 A118G genetic polymorphism may influence the requirement for oxycodone hydrochloride prolonged⁃release tablets and could serve as a potential biomarker to guide cancer pain treatment.

Key words: Severe  cancer  pain,  Oxycodone  hydrochloride  prolonged?release  tablets,  Genetic  polymorphism,  Analgesia,  Initial  titration  dose

中图分类号: 

  • R730.5