处方类阿片药物使用与腰痛关联——两样本孟德尔随机化分析

张 钟, 黎 李龙, 刘 小东, 秦 毅
暨南大学珠海临床医学院（珠海市人民医院　北京理工大学附属医院）

摘要


目的：本研究旨在利用两样本孟德尔随机化（MR）方法探讨处方阿片类药物使用与腰痛之间的因果关
系。通过遗传变异作为工具变量，模拟随机对照试验，以克服观察性研究中混杂因素的影响，从而更准确地评估阿
片类药物对腰痛风险的潜在因果作用。方法：本研究使用来自英国生物银行（UKB）的病例对照全基因组关联研
究（GWAS）汇总统计数据，包含78，808名参与者（22，982例阿片类药物使用者和55，826例非使用者）。腰痛的
结局数据来自芬兰生物库的GWAS结果，包含42，521例病例组和353，224例对照组。通过多种孟德尔随机化方法
（IVW、加权中值法、MR Egger）分析因果关系。结果：逆方差加权法（IVW）显示阿片类药物使用显著增加腰痛
的风险（OR=1.146，95% CI 95% CI[1.086，1.209]，p<0.01）。加权中值法的结果支持这一发现（OR=1.119，95% CI
[1.029，1.216]，p<0.01）。异质性及水平多效性分析未发现显著偏倚（MR Egger截距=0.00263，p=0.64，Cochran Q
检验p=0.401），整体因果估计结果稳健。讨论：本研究通过MR方法提供了处方阿片类药物使用与腰痛风险增加的
因果关联证据。研究结果支持了减少阿片类药物用于腰痛管理的必要性，并提示未来在特定人群中的进一步验证研
究，以帮助优化临床疼痛管理策略。

关键词


腰痛；阿片类药物；孟德尔随机化分析

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