Response to Succinylcholine in Patients Carrying the K-Variant of the Butyrylcholinesterase Gene
Response to Succinylcholine in Patients Carrying the K-Variant of the Butyrylcholinesterase Gene
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DOI：
10.1213/ane.0b013e318280a3f3
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发表时间：
2013-03-01
影响因子：
5.7
通讯作者：
Gatke, Mona Ring
中科院分区：
文献类型：
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作者：
Bretlau, Claus;Soerensen, Martin Kryspin;Gatke, Mona Ring
背景技术背景：琥珀酰胆碱通常通过丁酰胆碱酯酶（BChE）快速代谢，但BChE的遗传变异可能会延长作用时间。Kalow（K）变异是丁酰胆碱酯酶基因（BCHE）中最常见的突变，存在于25%的高加索人中。K变异体对琥珀胆碱作用持续时间的意义尚未得到充分研究。我们的假设是，琥珀胆碱的作用时间将延长患者杂合子的K-变异基因型与正常基因型（野生型）相比：我们纳入了70例成人手术患者接受琥珀胆碱1 mg/kg的快速序列诱导。使用尺神经刺激和加速度肌描记术进行神经肌肉监测。琥珀酰胆碱的作用时间被定义为90%的时间恢复的第一次抽搐的四列（T-1 90%），BChE活性测定，并确定BCHE K和A（非典型）变异体的存在下，使用DNA analysis.Results：野生型BCHE存在于38例患者，21个杂合子的K-变异。K变异杂合子患者的平均（SD）T-1 90%为11.6（3.5）分钟，长于野生型基因型患者的9.5（2.7）分钟（P = 0.023），平均（95%置信区间）差异为2.1（0.3-4.0）分钟。K-变异杂合子患者的BChE活性为5978 U/L，野生型组为7703 U/L（P = 0.0045）。结论：我们得出结论，琥珀胆碱的平均作用时间延长了患者的K：变异等位基因杂合子最多4分钟，相对于野生型，但这种差异相对于所有患者的广泛变异性和恢复时间重叠较小。（Anesth Analg 2013;116：596-601）
BACKGROUND: Succinylcholine is usually metabolized quickly by the butyrylcholinesterase enzyme (BChE) but genetic variants of BChE may prolong the duration of action. The Kalow (K) variant is the most common mutation in the butyrylcholinesterase gene (BCHE), being present in 25% of Caucasians. The significance of the K-variant for the duration of action of succinylcholine has not been well studied. Our hypothesis was that the duration of action of succinylcholine would be prolonged in patients heterozygous for the K-variant genotype compared with the normal genotype (wild-type).METHODS: We included 70 adult surgical patients who received succinylcholine 1 mg/kg for rapid sequence induction. Neuromuscular monitoring was performed using ulnar nerve stimulation and acceleromyography. Duration of action of succinylcholine was defined as the time to 90% recovery of first twitch in train-of-four (T-1 90%), BChE activity was determined, and the presence of BCHE K and A (atypical) variants were determined using DNA analysis.RESULTS: The wild-type BCHE was present in 38 patients, and 21 were heterozygous for the K-variant. Mean (SD) T-1 90% in patients heterozygous for the K-variant, 11.6 (3.5) minutes, was longer than in patients with the wild-type genotype, 9.5 (2.7) minutes (P = 0.023), with a mean (95% confidence interval) difference of 2.1 (0.3-4.0) Minutes. Patients heterozygous for the K-variant had a BChE activity of 5978 U/L compared with 7703 U/L in the wild-type group (P = 0.0045).CONCLUSION: We conclude that the mean duration of action of succinylcholine is prolonged for the patient heterozygous for the K:variant allele by at most 4 minutes relative to the wild-type, but this difference is small relative to the wide variability and overlap in recovery times among all patients. (Anesth Analg 2013;116:596-601)