基于多祖源孟德尔随机化分析的血液金属与胰腺癌风险因果关联研究
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1中南大学湘雅三医院 健康管理医学中心,湖南 长沙 410013;2中南大学湘雅三医院 肝胆胰外Ⅱ科,湖南 长沙 410013;3中南大学湘雅三医院 手术中心,湖南 长沙 410013

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袁挺,中南大学湘雅三医院主治医师,主要从事胰腺癌基础及临床方面的研究。

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A causal association study of blood metals and pancreatic cancer risk based on multi-ancestry Mendelian randomization analysis
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1Health Management Medical Center, the Third Xiangya Hospital, Central South University, Changsha 410013, China;2Department of Hepatobiliary and Pancreatic Surgery Ⅱ, the Third Xiangya Hospital, Central South University, Changsha 410013, China;3Surgical Center, the Third Xiangya Hospital, Central South University, Changsha 410013, China

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    摘要:

    背景与目的 胰腺癌(PC)预后差,针对其潜在可干预危险因素的病因学证据仍较有限。血液金属参与氧化应激、代谢调控和免疫反应等多种生物学过程,但其与PC风险之间的因果关系尚不明确。本研究基于多祖源孟德尔随机化(MR)框架,系统评估42种血液金属水平与PC风险之间的潜在因果关联。方法 以东亚人群42种血液金属水平的全基因组关联研究(GWAS)汇总数据作为暴露数据,在3套PC GWAS数据中开展两样本MR分析,包括2套东亚人群数据和1套欧洲人群数据。采用逆方差加权法(IVW)进行主要分析,并以MR-Egger、weighted median和weighted mode作为补充分析。进一步对42种金属在3套PC GWAS数据中的IVW效应估计进行随机效应Meta分析,并采用Bonferroni校正和Benjamini-Hochberg错误发现率(FDR)方法进行多重比较校正。通过异质性检验、水平多效性检验、离群值分析、留一法及Steiger方向性检验评价结果稳健性,并采用MRlap评估东亚人群暴露与结局GWAS数据潜在样本重叠对MR估计的影响。结果 血浆铁在3套PC GWAS数据中均与PC风险呈方向一致的正向关联,均达到名义统计学显著水平。随机效应Meta分析显示,遗传预测的血浆铁水平升高与PC风险增加显著相关(合并OR=1.195,95% CI=1.089~1.311,P=1.73×10?4),且经42项Bonferroni校正后仍具有统计学意义(校正P=0.007;FDR校正P=0.007),队列间未见显著异质性(I2=0%)。血浆铜的跨队列Meta分析达到名义统计学显著,并通过FDR校正(FDR校正P=0.042),但未通过Bonferroni校正(Bonferroni校正P=0.085)。血浆铁的敏感性分析未发现明显的定向水平多效性、工具变量异质性、离群值或单一单核苷酸多态性驱动总体效应的证据,Steiger检验支持血浆铁至PC风险的因果方向。结论 多祖源、多金属MR分析提示,遗传预测的较高血浆铁水平与PC风险增加存在潜在因果关联,且该关联在跨队列Meta分析及严格多重比较校正后仍保持稳健。结果提示铁稳态可能参与PC发生的病因学过程,为进一步开展相关机制及风险干预研究提供了遗传学线索。

    Abstract:

    Background and Aims Pancreatic cancer (PC) has a poor prognosis, and etiological evidence regarding potentially modifiable risk factors remains limited. Blood metals are involved in oxidative stress, metabolic regulation, and immune responses, but their causal relationships with PC risk remain unclear. This study aimed to systematically evaluate the potential causal associations between 42 blood metal traits and PC risk using a multi-ancestry Mendelian randomization (MR) framework.Methods Genome-wide association study (GWAS) summary statistics for 42 blood metal traits in East Asian populations were used as exposure data. Two-sample MR analyses were conducted using three PC GWAS datasets, including two East Asian datasets and one European dataset. The inverse-variance weighted (IVW) method was used as the primary analysis, with MR-Egger, weighted median, and weighted mode as complementary approaches. IVW estimates for all 42 metals across the three PC GWAS datasets were subsequently combined using random-effects meta-analysis. Multiple testing was addressed using Bonferroni and Benjamini-Hochberg false discovery rate (FDR) correction. Heterogeneity, horizontal pleiotropy, outliers, leave-one-out analyses, and Steiger directionality testing were performed to assess robustness. MRlap was further used to evaluate the potential impact of sample overlap between the East Asian exposure and outcome GWAS datasets.Results Plasma iron showed directionally consistent positive associations with PC risk across all three PC GWAS datasets and reached nominal statistical significance in each dataset. Random-effects meta-analysis demonstrated that higher genetically predicted plasma iron levels were significantly associated with increased PC risk (pooled OR=1.195, 95% CI=1.089-1.311, P=1.73×10-4). This association remained significant after Bonferroni correction for 42 comparisons (adjusted P=0.007; FDR-adjusted P=0.007), with no significant between-dataset heterogeneity (I2=0%). Plasma copper showed a nominally significant meta-analytic association and remained significant after FDR correction (FDR-adjusted P=0.042), but not after Bonferroni correction (Bonferroni-adjusted P=0.085). Sensitivity analyses revealed no substantial evidence of directional horizontal pleiotropy, instrumental heterogeneity, outlier-driven effects, or single-variant-driven associations for plasma iron, and Steiger testing supported the direction from plasma iron to PC risk.Conclusion This multi-ancestry, multi-metal MR study provides genetic evidence supporting a potential causal association between higher genetically predicted plasma iron levels and increased PC risk. The association remained robust across outcome datasets and after stringent multiple-testing correction, suggesting that iron homeostasis may contribute to the etiology of PC and warranting further mechanistic and risk-intervention studies.

    图1 血液金属与PC风险的两样本MR分析全景图 A:环状热图展示42种金属在3套PC GWAS数据及4种MR分析方法下的P值,红色表示结果显著(P<0.05);B:热图展示相应OR值,红色表示风险增高(OR>1),蓝色表示风险降低(OR<1);C:森林图展示具有代表性的名义显著或跨队列效应方向一致的金属在不同PC GWAS数据中的IVW效应估计Fig.1 Overview of two-sample Mendelian randomization analyses of blood metal traits and pancreatic cancer risk A: Circular heatmap showing P values for 42 blood metal traits across three pancreatic cancer GWAS datasets and four MR methods, and the red indicates nominal statistical significance (P<0.05); B: Heatmap showing the corresponding OR, and the red indicates increased risk (OR>1), whereas the blue indicates decreased risk (OR<1); C: Forest plot showing IVW effect estimates for representative metal traits with nominal statistical significance or consistent effect directions across outcome datasets
    图2 血浆铁水平与PC风险的跨队列Meta分析Fig.2 Meta-analysis of the association between plasma iron levels and PC risk
    表 1 GWAS数据来源Table 1 Sources of GWAS data
    表 2 42种血液金属暴露的工具变量特征Table 2 Characteristics of instrumental variables for the 42 blood metal traits
    表 3 42种血液金属跨队列Meta分析及多重比较校正结果Table 3 Meta-analysis and multiple-testing correction of associations between 42 blood metal traits and PC risk
    表 4 基于跨性状LDSC的暴露与PC结局GWAS数据样本重叠评估Table 4 Assessment of potential sample overlap between blood metal exposure and PC outcome GWAS datasets using cross-trait LDSC
    表 5 血浆铁水平与PC因果关联的敏感性分析Table 5 Sensitivity analyses of the causal association between plasma iron levels and PC risk
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袁挺,严安,邓小娴,阳丽虹.基于多祖源孟德尔随机化分析的血液金属与胰腺癌风险因果关联研究[J].中国普通外科杂志,2026,35(8):1643-1653.
DOI:10.7659/j. issn.1005-6947.260295

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  • 收稿日期:2026-05-27
  • 最后修改日期:2026-08-21
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  • 在线发布日期: 2026-09-29
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