云南省德宏州人类免疫缺陷病毒／丙型肝炎病毒合并感染者肝脏损伤临床分析

Liver injury in patients with hepatitis C virus/human immunodeficiency virus coinfection in Dehong Prefecture, Yunnan Province

目的了解云南省德宏州HIV／HCV合并感染者肝脏损伤的状况。方法德宏州HIV感染者4784例，以抗HIV治疗前的AST、ALT作为肝功能异常指标，以AST和血小板比率指数（APRI）作为肝硬化指标，分析HCV感染与肝脏损伤的关系。组间比较采用χ^2检验和非参数秩和检验。肝脏损伤的影响因素采用多因素Logistic回归模型。结果4784例HIV感染者中抗-HCV阳性1447例，阳性率为30．2％；肝功能异常1996例，占41．7％；肝硬化636例，发生率为13．3％。HBV阴性、抗-HCV阳性者肝功能异常和肝硬化发生率分别为61．1％（821／1343）和24．1％（323／1343），显著高于抗-HCV阴性者的31．5％（974／3092）和7．5％（231／3092），差异有统计学意义（χ^2值分别为341．223和235．457，均P〈0．01）。多因素分析显示，抗-HCV阳性者发生肝功能异常、肝硬化的风险分别是阴性者的1．99（95％CI：1．66～2．37）倍、2．41（95％CI：1.90～3．04）倍。结论德宏州HIV／HCV合并感染者更易发生肝脏损伤。

Objective To evaluate liver injury in patients with hepatitis C virus （HCV）/human immunodeficiency virus （HIV） coinfection in Dehong Prefecture, Yunnan Province. Methods A total of 4 784 HIV-infected patients were enrolled in this study. Baseline aspartate aminotransferase （AST）, alanine aminotransferase （ALT） and AST-to-platelet ratio index （APRI） before HIV treatment were collected to analyze the relationship between HCV infection and liver injury. Data were analyzed by χ^2 test and nonparametric rank sum test when appropriate. Risk factors for liver injury were analyzed by multivariate Logistic regression. Results Totally 4 784 patients were included, of which 30.2% （1 447/ 4 784） were anti-HCV positive, 41.7% （1 996/4 784） had liver dysfunction and 13.3% （636/4 784） had liver cirrhosis. Prevalence of liver dysfunction （61.1%, 821/1 343） and cirrhosis （24.1%, 323/1 343） were significantly higher among anti-HCV-positive patients than anti-HCV-negative patients （31. 5%, 974/3 092, χ^2= 341. 223, P〈0. 01; 7. 5%, 231/3 092, χ^2=235. 457, P〈0. 01, respectively）. Multivariate Logistic regression showed that anti-HCV-positive patients suffered Significantly higher risk of liver dysfunction （OR=1. 99, 95% CI： 1.66-2.37） and liver cirrhosis （OR=2.41, 95%CI： 1.90- 3.04）. Conclusion Patients with HCV/HIV in Dehong Prefecture coinfection had a higher risk for liver injury.