德宏州HIV阳性美沙酮维持治疗人群中HCV感染与肝脏损伤的关系

发布时间：2018-11-22 16:34

【摘要】：目的了解云南省德宏州艾滋病病毒(HIV)阳性美沙酮维持治疗人群中,丙型肝炎病毒(HCV)感染与肝脏损伤的关系。方法以德宏州美沙酮维持治疗人群中有抗病毒史的HIV感染者为研究对象。以丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)中任一指标超过正常上限值,即认定为肝功能受损;以天冬氨酸氨基转移酶-血小板指数(APRI)作为肝硬化指数,分析研究对象在接受抗病毒治疗前HCV感染与肝脏损伤的关系。结果共纳入663名研究对象,其中男性占96.1%(637人);30~39岁者占57.3%(380人);汉族、傣族和景颇族分别占41.8%(277人)、31.4%(208人)和18.6%(123人);静脉注射吸毒途径感染HIV者占88.4%(586人)。HCV抗体阳性率为87.3%(579人);乙型肝炎病毒(HBV)表面抗原(HBsAg)阳性率为7.7%(51人)。HIV/HCV合并感染人群中发生肝脏损伤的比例较高:肝功能受损发生率为63.2%(366/579),肝硬化发生率为25.0%(144/575)。χ2分析显示:在排除了HBV的影响后,HCV阳性与AST、ALT、肝功能受损、肝硬化发生异常显著相关。多因素分析显示:HCV阳性者发生肝功能受损的风险是阴性者的2.10倍[95%可信区间(CI):1.28~3.43];HCV阳性者发生肝硬化的风险是阴性者的2.59倍(95%CI:1.29~5.19)。同时发现,HBV阳性、男性、年龄较大、少数民族、CD+4T淋巴细胞数减少是发生肝脏损伤的危险因素。结论 HIV阳性美沙酮维持治疗人群中,HCV阳性易导致病人发生肝脏损伤,需要关注其肝脏损伤情况,有条件应给与针对HCV抗病毒治疗。
[Abstract]:Objective to investigate the relationship between hepatitis C virus (HCV) (HCV) infection and liver injury in maintenance therapy population with (HIV) positive methadone in Dehong Prefecture, Yunnan Province. Methods HIV infected individuals with antiviral history in methadone maintenance therapy in Dehong were studied. If any of the indexes in (ALT), aspartate aminotransferase (AST) exceed the normal upper limit, the liver function is considered to be impaired. Using aspartate aminotransferase-platelet index (APRI) as cirrhosis index, the relationship between HCV infection and liver injury was analyzed. Results A total of 663 subjects were included, of whom 96.1% (637) were male, 57.3% (380) were 30 years old. 41.8% (277), 31.4% (208) and 18.6% (123) of Han nationality, Dai nationality and Jingpo nationality respectively, 88.4% (586) of them were infected with HIV via intravenous drug use route, 87.3% (579 cases) were infected with). HCV antibody. The positive rate of hepatitis B virus (HBV) surface antigen (HBsAg) was 7.7% (51 people). The incidence of liver function damage was 63.2% (366 / 579). The incidence of liver cirrhosis was 25.0% (144 / 575). 蠂 2 analysis showed that after excluding the effect of HBV, HCV positive was significantly correlated with AST,ALT, liver function impairment and liver cirrhosis. Multivariate analysis showed that the risk of liver function damage in HCV positive patients was 2.10 times higher than that in negative patients [95% confidence interval (CI): 1.28 3.43]. The risk of cirrhosis in HCV positive patients was 2.59 times higher than that in negative ones (95%CI:1.29~5.19). It was also found that HBV positive, male, older, ethnic minorities and decreased CD 4 T lymphocytes were risk factors for liver injury. Conclusion in the maintenance therapy population of HIV positive methadone, HCV positive may lead to liver injury in patients. It is necessary to pay attention to the condition of liver injury, and should be given antiviral therapy for HCV.
【作者单位】：复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室健康风险预警治理协同创新中心;云南德宏州疾病预防控制中心;芒市人民医院;瑞丽市人民医院;陇川县人民医院;盈江县人民医院;德宏州人民医院;梁河县人民医院;盈江县中医院;畹町医院;
【基金】：国家自然科学基金项目(81373062)~~
【分类号】：R512.91;R512.63

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