美沙酮维持治疗门诊服药人员HCV感染现状横断面调查

发布时间：2018-01-28 04:51

  本文关键词： HCV 肝纤维化 美沙酮维持治疗门诊 吸毒人群　出处：《中国疾病预防控制中心》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解美沙酮维持治疗(MMT)门诊服药人员丙型肝炎病毒(HCV)感染状况及感染者的肝纤维化程度和治疗需求,并探讨影响HCV感染者肝纤维化的因素。方法:本研究于2016年8-10月在云南、广西和甘肃三省的6所MMT门诊进行横断面调查,首先了解门诊服药人员HCV、HIV感染状况,再从中招募部分HCV抗体阳性服药人员进一步开展研究,收集转氨酶和年龄信息计算APRI和FIB4以评估其肝纤维化程度,并开展问卷调查收集其人口学特征、行为习惯、HCV相关治疗情况以及HIV-HCV合并感染状况等信息。结果:1.本研究的6所MMT门诊服药人员中,HCV抗体阳性率为48.5%(1438/2962),HIV 抗体阳性率为 9.7%(286/2962)。HIV-HCV 合并感染率为 9.0%(268/2962)。HCV抗体阳性者中HIV合并感染率为18.60%(268/1438),HIV抗体阳性者HCV合并感染率为93.7%(268/286)。2.本研究共招募652例MMT门诊HCV抗体阳性服药人员,调查对象的平均年龄为 43.6±7.1 岁,男性占 84.2%(549/652),汉族占 77.9%(508/652),初中及以下文化程度者占72.1%(470/652),已婚者占57.7%(376/652),待业或无业者占 56.6%(369/652),个人月均收入1000 元者占 56.9%(371/652)、≥2000元者占 26.1%(170/652)。3.调查对象中,吸毒年限以20～24年为主,占32.7%(213/652);曾静脉注射吸毒者占84.4%(550/652);从未饮酒者占56.9%(371/652)。4.调查对象能正确回答所有丙型肝炎相关问题的为24.1%(157/652)。91.9%听说过丙型肝炎,对其各种传播途径的知晓率均超过65%,对其危害的知晓率都在80%以上,对丙型肝炎能够治愈的知晓率为52.3%。5.652例HCV抗体阳性服药人员中,经APRI和FIB4筛查75.9%(495/652)无肝纤维化,24.1%(157/652)有肝纤维化者,肝纤维化F2～F3期者占11.3%(74/652),F4 期者占 12.7%(83/652)。6.652例调查对象中25.9%(169/652)接受过丙型肝炎相关治疗,10.0%(65/652)接受过丙型肝炎抗病毒治疗;肝纤维化F0-F1期者24.6%(122/495)接受过丙型肝炎相关治疗,10%(50/495)接受过抗病毒治疗;F2-F3期者29.7%(占22/74)接受过丙型肝炎相关治疗,12.2%(9/74)接受过抗病毒治疗;F4期者30.1%(25/83)接受过丙型肝炎相关治疗,7.2%(6/83)接受过抗病毒治疗。7.单因素Logistic回归分析中年龄≥40岁(0R=2.0,95%CI:1.3-3.1)、总是饮酒(OR=1.6,95%CI:1.0-2.5)是HCV感染者肝纤维化的相关影响因素。多因素Logistic回归分析中吸毒年限≥30年(OR=6.5,95%CI:1.5-28.6)是HCV感染者肝纤维化的相关影响因素。结论:MMT门诊服药人员HCV感染率远高于HIV感染率,有四分之一左右的HCV感染者不知晓自己的感染状态。HCV感染者中出现肝纤维化并进行过抗病毒治疗的比例低,需要优先治疗的人中,实际治疗人数较少。吸毒年限等是HCV感染者肝纤维化发生的相关因素。建议加强MMT门诊丙型肝炎相关知识的宣传教育力度;进一步扩大HCV及其肝纤维化的检测;并采取适当的方法帮助服药人员降低甚至戒除毒品依赖。
[Abstract]:Objective: to investigate the status of hepatitis C virus (HCV) infection and the degree of hepatic fibrosis and the need for treatment of patients with methadone maintenance therapy (MMTM) outpatient. Methods: a cross-sectional investigation was conducted in 6 MMT outpatient clinics in Yunnan, Guangxi and Gansu from 2016 to October. First of all, to understand the HIV infection in outpatients, and then to recruit some HCV antibody positive drug users to carry out further research. Transaminase and age information were collected to calculate APRI and FIB4 in order to evaluate the degree of hepatic fibrosis. A questionnaire survey was conducted to collect their demographic characteristics and behavior habits. Results\\\ among the 6 MMT outpatients in this study, there were 6 drug users in MMT outpatient clinic. Results\\\%\%\%\%\%\%. The positive rate of HCV antibody was 48.5% 1438% 2962%. The positive rate of HIV antibody is 9. 7% 286 / 2962%. HIV-HCV coinfection rate is 9. 0% 268% 2962%). The co-infection rate of HIV was 18.60% / 1438% in HCV antibody positive patients. The co-infection rate of HCV in patients with positive HIV antibody was 93.7R / 2860.2. 652 HCV antibody positive drug users in MMT outpatient clinic were recruited in this study. The average age of the subjects was 43.6 卤7.1 years old, 84.2% 549% 652% in males and 77.9% / 658% in Han nationality. 72.1% of the students with junior high school or lower education had 470% 652%, 57.7% of the married had 376% 652%, and 56.6% of the unemployed or unemployed had 369% 652%. The average monthly income of individuals was 1000 yuan, accounting for 56.9% 371R / 652N, and 26.1RMB / 6520.3. of the survey subjects. The number of years of drug abuse was mainly 20 ~ 24 years, accounting for 32.7% of 652%; Intravenous drug users accounted for 84.4% of the 550% 652%; The number of people who never drank was 56.9% 371r652k.4. the subjects who answered all the questions related to hepatitis C correctly were 24.11,157 / 652. 91.9% had heard of hepatitis C. The awareness of its various ways of transmission is over 65%, and the awareness rate of its harm is more than 80%. The rate of knowing that hepatitis C could be cured was 52.3% and 5.652 cases of HCV antibody positive drug users. Patients with hepatic fibrosis were screened by APRI and FIB4 (49.5% 652) without hepatic fibrosis 24.1kW 157R / 652). Hepatic fibrosis in F2F3 stage accounted for 11.3% (74% 652%). Patients with stage F4 accounted for 83.652 / 652 subjects who had received hepatitis C related treatment (25.9% 652 cases). (10.0% 65% 652) received antiviral therapy for hepatitis C; The patients with hepatic fibrosis in F0-F1 stage (24.62 / 495) received hepatitis C related treatment (10 / 50 / 495) and received antiviral therapy. The patients with stage F2-F3 (22 / 74) had received antiviral therapy. Patients with stage F4 (30.1 / 83) received hepatitis C related treatment. (7. 2 / 83) received antiviral therapy .7.The univariate Logistic regression analysis showed that the age 鈮，

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