中国美沙酮门诊吸毒人群HIV和HCV感染状况的Meta分析

发布时间：2018-02-20 04:04

本文关键词： HIV HCV HIV-HCV合并感染美沙酮维持治疗 Meta分析　出处：《南通大学》2013年硕士论文　论文类型：学位论文

【摘要】：背景：中国在2004年开始实施美沙酮维持治疗(Methadone Maintenance Treatment,MMT),最初只有8个门诊,到2011年底已扩展到738个门诊。有不少研究报告了MMT门诊入组人群HIV和HCV的流行情况,但不同研究的感染率差异较大。本研究的目的是通过Meta分析,综合评价MMT入组人群HIV和HCV的流行情况,并比较不同地区的差异及时间变化趋势。方法：设定中文关键词为(“美沙酮”或“美沙酮维持治疗”或“美沙酮维持”)和(“HIV”或“艾滋病”或“HCV”或“丙肝”或“合并感染”)和(“中国”或“中国大陆”),英文关键词为"Methadone" OR "Methadone Maintenance Treatment" OR "Methadone Maintenance Therapy" OR "Methadone Maintenance") AND("HIV" OR "AIDS" OR "HCV" OR "hepatitis C viru" OR "co-infection") AND("China" OR "China Mainland"),搜索2004-2011年中国知网CNKI.维普期刊服务平台、万方数据知识服务平台和PubMed四个数据库的文献。纳入的文献中应有MMT门诊吸毒人群基线的HIV或HCV的感染情况,且HIV和HCV感染有实验室血清学诊断,文献必须包含研究地点、研究时间和样本量等信息。采用Comprehensive Meta-Analysis软件,分析全国MMT入组人群HIV.HCV和HIV-HCV合并感染的总体感染率、不同地区的感染率及时间趋势。结果：本研究共筛选出90篇文献(2篇英文和88篇中文),覆盖全国19个省份,样本量中位数为300,四分位数间距：175-512(样本范围38-8662人)。全国MMT门诊中吸毒人群的HIV-HCV和HIV-HCV合并感染的流行情况分别为6.0%(95%CI:4.7%-7.7%).60.1％(95%CI:52.8%-67.0%)和4.6%(95%CI：2.9%-7.2%)。高发区的感染率明显高于低发区(HIV:17.5%(95%CI:14.0%-21.6%) Vs2.4%(95%CI:1.6%-3.5%):HCV:70.2%(95%CI:62.6%-76.8%)Vs55.5%(95%CI:46.4%-64.2%);HlV-HCV合并感染8.0%(95%CI:4.8%-12.9%)VS2.5％(95％CI:1.4%-4.4%))。地区差异是影响HIV和HCV流行异质性的主要原因。没有发现明显的时间趋势(HIV:p=0.282；HCV:p=0.891；HIV-HCV合并感染：p=0.484)。结论：中国MMT项目正在快速发展,纳入门诊的HIV阳性者有待进一步提高,扩大MMT规模应尽可能覆盖更多的感染者,以减少艾滋病的传播。HCV的高感染率提示在关注吸毒人群HIV防治的同时,不能忽视HCV的干预。
[Abstract]:Background: methadone Maintenance treatment was introduced in China in 2004. There were only 8 outpatient clinics in China, but by end of 2011 it had been extended to 738 outpatient clinics. Many studies have reported the prevalence of HIV and HCV in MMT outpatients. The purpose of this study was to evaluate the prevalence of HIV and HCV in MMT population by Meta analysis. Methods: Chinese keywords ("methadone" or "methadone maintenance therapy" or "methadone maintenance") and ("HIV" or "AIDS" or "HCV" or "hepatitis C" or "combination") were compared. And ("Methadone" OR "Methadone Maintenance Treatment" OR "Methadone Maintenance Therapy" OR "Methadone Maintenance") and ("HIV" OR "AIDS" OR "HCV" OR "hepatitis C viru" OR "co-infection") and ("China" OR "China Mainland"), search CNKI.Weip Journal Service platform 2004-2011. Literature on the four databases of Wanfang data knowledge Service platform and PubMed. The literature included should include the baseline HIV or HCV infection of drug users in MMT outpatient clinics, and the infection of HIV and HCV should have laboratory serological diagnosis, and the literature must include the research site. Comprehensive Meta-Analysis software was used to analyze the total infection rate of HIV.HCV and HIV-HCV co-infection in MMT population in China, and the infection rate and time trend in different regions. Results: a total of 90 articles in English and 88 in Chinese were selected, covering 19 provinces in China. The prevalence of HIV-HCV and HIV-HCV co-infection among drug users in the MMT outpatient service was 6.095 CI4.7- 7.77.7cn, and 60.1% 95 CI: 52.8-67.0) and 4.695CI2.9-7.22.21.The infection rate in the high incidence area was obviously higher than that in the low incidence area, HIV17.55-95CI14.0- 21.6. Vs2.4CI2.5CI1.6- 3.50.75CIQ / 70.2CIQ / 62.62.6- 76.8Vs55.55.55.55.The infection rate in the high incidence area was obviously higher than that in the low incidence area HIV17.55-95CI14.0- 21.62.55.The infection rate was significantly higher than that in the low incidence area.) Vs2.495CI1.6-3.55.55CIQ / V70.250CIQ = 62.66-76.8Vs55.55.55.The infection rate was significantly higher than that in the low incidence area (HIV 17.55-95CI14.0-21.66.60). The main reason that influence the heterogeneity of HIV and HCV epidemic is regional difference. No obvious time trend has been found. No obvious time trend has been found in HIV: p0.891HIV-HCV co-infection. Conclusion: the MMT project in China is developing rapidly, the HIV positive patients who are included in the outpatient clinic need to be further improved, and the expansion of the MMT scale should cover as many patients as possible. In order to reduce the spread of HIV / AIDS, the high infection rate of HCV suggests that the intervention of HCV should not be ignored while paying attention to the prevention and treatment of HIV among drug users.
【学位授予单位】：南通大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91;R512.63

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