Objective: To explore the SNP effects of patatin-like phospholipase domain which containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2) gene, environmental effects of smoking, alcohol drinking and interaction between gene-gene, gene-environment and drinking-smoking on hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). Methods: We collected anticoagulant peripheral blood from patients of HBV-HCC, chronic hepatitis B (CHB), liver cirrhosis (LC) and from healthy controls to detect the single nucleotide polymorphism (SNP) of patatin-like phospholipase domain containing 3 (PNPLA3) gene loci rs738409 and transmembrane 6 superfamily member 2 (TM6SF2) gene loci rs58542926, using the flight mass spectrometry method. The optimal assignment value of gene polymorphisms was defined by using the online SNP stats. Hardy-Weinberg (H-W) balance was tested for SNP. Effects of the genetic and environmental factors to HBV-HCC were analyzed by using the multiple classification logistic regression method. The gene-gene, gene-smoking and alcohol drinking interaction effects were investigated by Fork-Life analysis and binary logistic regression methods. Results: The frequency distribution of CHB group rs738409 loci seemed not in conformity with the H-W balance (χ(2)=11.980, P<0.005). Two loci frequency distributions in the other groups were all in accordandce with the H-W balance. After adjusting for influences on age and sex and comparing to the healthy group, the rs58542926 mutation appeared as OR=1.659, 95%CI: 1.026-2.684, P=0.039, in the HBV-HCC group. When comparing to CHB group, the HBV-HCC group presented that drinking as OR=1.680, 95%CI: 1.121-2.519, P=0.012. When comparing to the LC group, the ORs of drinking and smoking were 1.539 (1.071-2.213) and 1.453 (1.005-2.099) respectively, in the HBV-HCC group. When comparing to the CHB+LC group, interactions between the HBV-HCC group were found rs738409 and rs58542926 on additive model OR=1.548 (U=1.885, P=0.029) and OR=1.658 (P=0.024) on logistic regression model while drinking was rs738409 on interaction additive model with OR=1.811(U=1.965, P=0.024). As for drinking and mutation of rs738409, the multiplication model of logistic regression showed no statistically significant differences. Interaction between smoking and drinking appeared as OR=1.756 (P<0.001) in the logistics regression multiplication model. Conclusions: Factors as mutation of TM6SF2, smoking and drinking all appeared as risk factors for HBV-HCC. Mutations of both PNPLA3 and TM6SF2, together with smoking and drinking all served as risk factors for HBV-HCC. However, the mutation of single PNPLA3 appeared as a protective factor on HBV-HCC.
目的： 探讨PNPLA3、TM6SF2基因多态性及其与吸烟、饮酒交互作用对HBV相关肝癌（hepatitis B virus-associated hepatocellular carcinoma，HBV-HCC）的影响。 方法： 收集2010年1月至2014年3月HBV-HCC患者、慢性乙型肝炎（乙肝）患者（CHB）、肝硬化患者（LC）以及健康体检者的血液标本，应用飞行质谱技术检测patatin样磷脂酶域3（PNPLA3）基因位点rs738409和6号跨膜超家族成员2（TM6SF2）基因位点rs58542926的单核苷酸多态性（SNP）。利用在线SNP stats寻找基因多态性的最优赋值方法；检验SNP是否符合哈-温（H-W）遗传平衡定律；采用多分类logistic回归分析PNPLA3和TM6SF2多态性及吸烟、饮酒因素对HBV-HCC的影响，采用叉生分析和二分类logistic回归分析探讨基因-基因、基因-吸烟、饮酒交互作用对HBV-HCC的影响。 结果： H-W遗传平衡检验结果显示，CHB组rs738409位点的基因型频率分布不符合H-W遗传平衡定律（χ(2)=11.980，P<0.005），CHB组rs58542926位点、HBV-HCC组和LC组rs738409和rs58542926位点均符合H-W遗传平衡定律；调整年龄、性别的影响后，与健康体检者相比，HBV-HCC组rs58542926突变的OR=1.659，95%CI：1.026~2.684，P=0.039。与CHB组相比，HBV-HCC组饮酒的OR=1.680，95%CI：1.121~2.519，P=0.012。与LC组相比，HBV-HCC组饮酒与吸烟的OR值（95%CI）分别为1.539（1.071~2.213）和1.453（1.005~2.099）。交互作用分析显示，HBV-HCC组与CHB+LC组相比，rs738409与rs58542926交互作用的叉生分析相加模型OR=1.548（U=1.885，P=0.029），logistic回归相乘模型OR=1.658（P=0.024）；饮酒与rs738409的交互作用叉生分析，饮酒且rs738409突变相加模型OR=1.811（U=1.965，P=0.024），相乘模型无统计学意义；logistic回归相乘模型吸烟与饮酒的交互作用OR=1.756（P<0.001）。 结论： TM6SF2基因突变、吸烟、饮酒是HBV-HCC的危险因素，PNPLA3与TM6SF2基因都突变、饮酒并且吸烟是HBV-HCC的危险因素。PNPLA3的单基因突变可以减弱饮酒对HBV-HCC的危害。.
Keywords: Carcinoma, hepatocellular; Hepatitis B virus; Interaction effect; Patatin-like phospholipase domain containing 3; Transmembrane 6 superfamily member 2.