大理地区吸毒人群HIV、HCV感染状况及HCV基因型分布特征调查

发布时间：2018-03-01 11:51

  本文关键词： HIV感染 HCV感染 HCV基因型 吸毒人群 大理地区　出处：《大理大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的以云南省大理州戒毒所吸毒哨点监测的吸毒人群为研究对象,了解此人群HIV、HCV感染状况;评估该人群与HIV、HCV感染相关的高危因素及HCV感染的基因型分布及分子流行病学特征,可以为今后更大范围内更有效地推广和完善哨点监测工作提供科学依据,以帮助有关部门制定更加合理地预防控制策略。研究方法1、按照《云南省艾滋病哨点监测方案(2015年版)》要求,在2015年1月1日~2015年6月30日监测期内,对大理州强制戒毒所新入所的423名吸毒者(包括口吸和注射吸毒者),采集静脉血3~5ml,检测HIV和HCV的感染情况。2、采用病毒RNA核酸提取试剂盒,提取196份HCV抗体阳性血样的RNA,逆转录PCR法扩增HCV NS5B区段基因系列,PCR产物纯化后进行测序,运用Clustal X1.83及MEGA5.0软件,对所有样本核酸测序系列与基因库中HCV亚型的参考序列进行比对;构建系统发育树;确定该人群的基因分型。3、结合问卷调查资料,运用统计学方法分析与HIV、HCV感染相关的危险因素及不同性别、年龄、是否合并HIV感染和不同地区报道的HCV感染的基因型分布关系。结果1、在423名吸毒人员中HIV感染率为19.4%(82/423),HCV感染率为46.3%(196/423),在82例HIV感染者中,有96.3%(79/82)感染了HCV。多因素分析结果表明,注射吸毒年限、有注射吸毒史、共用针具不仅是HIV感染的高危因素,也是HCV感染的高危因素;此外,HCV感染还与年龄、每天注射吸毒次数正相关。2、196份HCV抗体阳性样本经过扩增和测序,成功获得NS5B区段系列90条。大理地区90名吸毒者中,共发现3种HCV主要基因型:1型,3型和6型,其中以3型为主,占总数的46.67%(42/90),其次为6型,占35.56%(32/90),1型的比例最少,占17.77%(16/90)。在3种主要基因型中存在7个基因亚型,其中3b是主要的基因亚型,占28.89%(26/90),其他亚型依次为6n(23.65%,21/90),3a(17.78%,16/90),1b(10.00%,9/90),6u(8.89%,8/90),1a(7.78,7/90)6a(3.33%,3/90)。3、大理地区吸毒人群HCV基因亚型的分布在年龄组间具有差异性(χ=14.230,P0.05),35岁组年轻吸毒者1b和6u亚型的比例较高;且1b和6u亚型NS5B区基因平均距离最短,1b和6u亚型在35岁组年轻吸毒者中流行传播的时间较短,该人群更容易被感染。而3a,3b和6n亚型的NS5B区基因平均距离较大,三类基因亚型在大理地区≥35岁组吸毒者中流行的时间较长,是该人群的传统毒株。4、大理地区吸毒人群HCV基因亚型的分布与其他地区相比具有差异性(P0.05),受地理区域影响,该人群HCV基因分布与滇西南的德宏地区相近,以3b亚型为主,6n亚型次之,1a和6u亚型占有一定比例,6a亚型比例很少;不同于滇中东的昆明及红河地区,以3b亚型为主,3a亚型次之,1b和6a亚型占有一定比例。结论1、大理地区吸毒人群HIV感染率为19.4%,HCV感染率为46.3%,其中HIV感染阳性人群(82例))中并HCV感染率高(96.3%,79/82),其机制有待研究。2、有注射吸毒史、注射吸毒年限、共用针具是HIV和HCV感染的高危因素。3、大理地区吸毒人群中共发现3种HCV主要基因型:1型,3型和6型,其中以3型为主(46.67)%,其次为6型(35.56%),1型的比例最少(17.77%)。在3种主要基因型中存在7个基因亚型,其中3b是主要的基因亚型(28.89%),其他亚型依次为6n(23.65%),3a(17.78%),1b(10.00%),6u(8.89%),1a(7.78%)和6a(3.33%),呈现一定的地理分布特征。
[Abstract]:The purpose of the study in Yunnan Prefecture of Dali province drug addiction treatment center sentinel surveillance of drug users as the research object, understand the population HIV, HCV infection status; assessment of the population with HIV and related risk factors of HCV infection and genotype distribution and molecular epidemiology of HCV infection, for the future of greater scope to more effectively promote and improve the sentinel surveillance work to provide a scientific basis, to help the relevant departments to develop more reasonable prevention and control strategies. 1 research methods, in accordance with the "surveillance of AIDS in Yunnan province (2015 Edition) >, in January 1, 2015 ~ June 30, 2015 during the monitoring period, the state of Dali compulsory detoxification institute into 423 new drug addicts (including smoking and injecting drug users), venous blood 3~5ml, HIV and HCV detection of.2 infection, the virus RNA nucleic acid extraction kit to extract 196 HCV antibody positive blood samples RNA, RT PCR Amplification of HCV NS5B gene segment, the purified PCR products were sequenced by Clustal X1.83 and MEGA5.0 software, the reference sequence for all sample nucleic acid sequencing and gene library series HCV subtype in comparison; phylogenetic tree; determine the population genotype.3, combined with the questionnaire survey data, analysis and application HIV statistical methods, HCV infection related risk factors and different gender, age, whether the combined genotype reported HIV infection and HCV infection in various regions of the distribution. The results in 1, 423 drug addicts in the HIV infection rate was 19.4% (82 /423), HCV infection rate was 46.3% (196/423), in 82 cases of HIV infection, 96.3% (79/82) infected HCV. multivariate analysis showed that age of drug injection, injection drug use, needle sharing is not only the risk factors of HIV infection, the risk factors for HCV infection; in addition, HCV infection is related to age, every 澶╂敞灏勫惛姣掓�℃暟姝ｇ浉鍏�.2,196浠紿CV鎶椾綋闃虫，

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