目的:探讨循环瘦素水平与结直肠腺瘤和结直肠癌风险之间的因果关系。
方法:我们收集了497例结直肠腺瘤患者的人口统计学和临床数据以及血清样本,955例结直肠癌患者,浙江大学医学院附属第一医院911名健康人,浙江省肿瘤医院,诸暨人民医院,林安区第一人民医院。选择瘦素的仪器变量并进行基因分型试验。采用logistic回归模型和分层分析评价血清瘦素水平与结直肠腺瘤,结直肠癌,以及结直肠腺瘤向结直肠癌的进展。遗传风险评分(GRS)和单核苷酸多态性(SNP)进一步用作单样本和双样本孟德尔随机化分析中的工具变量,利用两阶段最小二乘法和逆方差加权方法来估计瘦素水平与结直肠腺瘤风险的因果关系。结直肠癌,结直肠腺瘤进展为结直肠癌。
结果:瘦素水平高,与最低四分位数相比,与结直肠腺瘤呈正相关(P=0.005),与结直肠癌呈负相关(P<0.001),与结直肠腺瘤进展为结直肠癌的风险呈正相关(P<0.001)。孟德尔随机化分析显示瘦素的GRS,无论加权与否,与结直肠腺瘤的风险没有显着相关,结直肠癌,或结直肠腺瘤进展为结直肠癌,孟德尔随机双样本研究也不支持瘦素与结直肠癌风险的相关性(P>0.05)。
结论:尽管病例对照研究表明瘦素与结直肠腺瘤的风险可能相关,结直肠癌,结直肠腺瘤进展为结直肠癌,孟德尔随机化研究不支持瘦素与结直肠腺瘤风险的因果关系。结直肠癌,或结直肠腺瘤进展为结直肠癌。
OBJECTIVE: To explore the causal association between circulating
leptin levels and the risk of colorectal adenoma and colorectal cancer.
METHODS: We collected demographic and clinical data and serum samples from 497 patients with colorectal adenoma, 955 patients with colorectal cancer, and 911 healthy individuals from the First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Cancer Hospital, Zhuji People\'s Hospital, and Lin\'an District First People\'s Hospital. Instrumental variables of
leptin were selected and genotyping tests were performed. A logistic regression model and stratified analysis were used to evaluate the association of serum
leptin levels with colorectal adenoma, colorectal cancer, and the progression of colorectal adenoma to colorectal cancer. Genetic risk score (GRS) and single nucleotide polymorphisms (SNPs) were further used as instrumental variables in one-sample and two-sample Mendelian randomization analyses leveraging two-stage least squares and inverse-variance weighted methods to estimate the causal association of leptin levels with the risk of colorectal adenoma, colorectal cancer, and progression of colorectal adenoma to colorectal cancer.
RESULTS: High levels of
leptin, compared with its lowest quartile, were positively correlated with colorectal adenoma (P=0.005) and negatively with colorectal cancer (P < 0.001) and the risk of progression of colorectal adenoma to colorectal cancer (P < 0.001). Mendelian randomization analysis showed that GRS of leptin, either weighted or not, was not significantly correlated with the risk of colorectal adenoma, colorectal cancer, or the progression of colorectal adenoma to colorectal cancer, nor did the two-sample Mendelian randomization study support an association between leptin and the risk of colorectal cancer (P>0.05).
CONCLUSIONS: Although the
case-control study suggests probable correlations of
leptin with the risk of colorectal adenoma, colorectal cancer, and colorectal adenoma progression to colorectal cancer, Mendelian randomization studies did not support a causal association of leptin with the risks of colorectal adenoma, colorectal cancer, or colorectal adenoma progression to colorectal cancer.