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目的评估瘦素基因(LEP)G2548A单核苷酸多态性(SNP)及环境因素与胆囊胆固醇结石发病危险的关联性,同时探究该多态性位点与环境因素对胆囊胆固醇结石的发生是否存在交互作用。方法收集符合条件的胆囊胆固醇结石患者200例进行1∶2匹配的病例对照研究(对照组400例)。应用高分辨率熔解曲线(highresolution melting,HRM)技术作基因分型检测并对结果进行测序验证,采用多因素分析探索基因多态性及血清瘦素水平与胆囊胆固醇结石的关联性。采用多因子降维法(multifactor dimensionality reduction,MDR)探索基因与环境因素的交互作用对胆囊胆固醇结石发病的影响。结果通过HRM基因分型检测,共得到LEP G2548A位点3种基因型,分别为野生型GG(52例),突变杂合型GA(192例)和突变纯合型AA(356例)。该SNP位点在对照组中的基因型分布均符合Hardy-Weinberg遗传平衡(P>0.05)。LEP G2548A位点AA基因型携带者血清瘦素水平高于GA/GG基因型携带者,差异有统计学意义(H=6.83,P<0.05)。多因素条件logistic回归分析结果显示,在调整年龄、性别以及其他影响因素后,胆固醇结石危险因素是:血清高瘦素水平[标准偏回归系数(β)=0.781,比值比(OR)=5.012,95%可信区间(95%CI):3.248~7.734]、LEP G2548A突变纯合子AA基因型(β=0.527,OR=2.292,95%CI:1.012~5.193)、胆结石家族史(β=0.267,OR=2.984,95%CI:1.329~6.700)、高收缩压(β=0.239,OR=1.927,95%CI:1.140~3.255)以及吸烟(β=0.236,OR=1.717,95%CI:1.006~2.928);而保护因素是:饮浓茶习惯(β=-0.477,OR=0.552,95%CI:0.336~0.907)与坚持锻炼(β=-0.252,OR=0.591,95%CI:0.395~0.882)。MDR分析结果显示,饮茶习惯-LEP G2548A多态性-血清瘦素水平组合为最优基因-环境交互作用模型。结论 LEP G2548A位点AA基因型可能通过影响血清瘦素水平增加发生胆囊胆固醇结石风险,而携带AA基因型且有饮淡茶习惯的血清高瘦素水平者对胆囊胆固醇结石可能更加易感。
Objective To evaluate the association between single nucleotide polymorphism (SNP) of G2548A in leptin gene (LEP) and the risk of gallstone in gallbladder, and to explore the relationship between polymorphism site and environmental factors in gallbladder cholesterol gallstone There is interaction. Methods A matched case-control study was conducted in 200 patients with cholecystolithiasis (matched control group, 400 cases). High resolution melting technique (HRM) was used to detect genotypes and sequencing results. Multivariate analysis was used to explore the association between genetic polymorphisms and serum leptin level and cholesterol gallstone in gallbladder. Multifactor dimensionality reduction (MDR) was used to explore the effect of the interaction between gene and environmental factors on the pathogenesis of gallstone gallstone. Results Three genotypes of LEP G2548A locus were detected by HRM genotyping, including wild-type GG (52 cases), mutant heterozygous GA (192 cases) and mutant homozygous AA (356 cases). The genotype distribution of the SNP locus in the control group was in line with the Hardy-Weinberg genetic balance (P> 0.05). The level of serum leptin in AA genotype of LEP G2548A locus was higher than that of GA / GG genotype (H = 6.83, P <0.05). Multivariate conditional logistic regression analysis showed that the risk factors for cholesterol gallstone were: serum leptin level [standard partial regression coefficient (β) = 0.781, odds ratio = 5.012, 95%) after adjustment for age, gender and other factors, (95% CI: 3.248-7.734), LEP G2548A mutation homozygous AA genotype (β = 0.527, OR = 2.292, 95% CI: 1.012-5.193), family history of gallstone (β = 0.267, OR = 2.984, 95% CI: 1.329-6.700), high systolic blood pressure (β = 0.239, OR = 1.927, 95% CI: 1.140-3.255) and smoking (β = 0.236, OR = 1.717, 95% CI: 1.006-2.928) ), While the protective factors were: drinking tea habits (β = -0.477, OR = 0.552, 95% CI: 0.336-0.907) and insisting on exercise (β = -0.252, OR = 0.591, 95% CI: 0.395-0.882) . The results of MDR analysis showed that the tea drinking habit-LEP G2548A polymorphism-serum leptin level combination was the optimal model of gene-environment interaction. Conclusion AA genotype of LEP G2548A locus may play an important role in the pathogenesis of gallbladder cholesterol gallstone by influencing serum leptin level. Serum high leptin level with AA genotype and drink tea habit may be more susceptible to gallstone gallstone disease.