社区MMT门诊服药者HCV感染及其肝纤维化的影响因素分析

HCV infection and liver fibrosis among drug users in methadone maintenance treatment clinics

目的了解社区美沙酮维持治疗(MMT)门诊服药人员丙型肝炎病毒(HCV)的感染状况,以及感染者肝纤维化的进展程度,并分析其影响因素。方法 2016年8-9月在云南和甘肃5所MMT门诊,收集服药人员的HCV感染状况,并招募部分抗-HCV阳性者进行横断面研究,收集血样,计算APRI和FIB4以评估其肝纤维化程度,并调查其人口学特征、行为习惯、治疗情况以及艾滋病病毒(HIV)/HCV合并感染状况等。结果 5所MMT门诊在治人数合计2 343例,抗-HCV阳性868例(37.0%),HIV抗体阳性150例(6.4%),HIV/HCV合并感染138例(5.9%)。招募390例抗-HCV阳性服药人员为研究对象。其中103例(占26.4%)为肝纤维化程度F2期以上,57例为F4期,占14.6%。接受HCV抗病毒治疗者占13.3%(52/390)。采用HCV标准抗病毒治疗者中,用干扰素或长效干扰素者26例,用干扰素或长效干扰素联合利巴韦林的22例,用小分子药物的4例。多因素Logistic回归分析结果显示,饮酒2~4次/周[比值比(OR)=2.2,95%可信区间CI:1.2~4.2]、吸毒时间≥30年(OR=7.3,95%CI:1.4~37.5)、合并HIV感染(OR=0.4,95%CI:0.2~0.7)是肝纤维化进展的影响因素。结论 MMT门诊服药人员HCV感染率较高,实际接受HCV标准抗病毒治疗的比例偏低。饮酒、吸毒时间、合并HIV感染对肝纤维化的进展程度有重要的影响,应加强门诊工作人员的能力建设,使之能更好地对HCV感染者提供宣传教育、咨询及治疗服务。

Objective To understand HCV infection as well as the liver fibrosis progression among drug users in MMT（methadone maintenance treatment） clinics, and the influence factors associated with liver fibrosis. Methods From August to September 2016, a cross-sectional study was conducted among the HCV infected drug users in MMT clinics in Yunnan and Gansu provinces, with APRI and FIB4 calculated by AST, ALT and age, to analyse risk factors associated with liver fibrosis such as social demographic characteristics, habit, treatment and H IV/HCV coinfection. Results In five MMT clinics, the rates of HCV antibody positive, HIV positive and HIV-HCV coin- fectionwere 37. 0% （868/2343）, 6.4% （150/2343） and 5.9（138/2343）. Of the 390 participants infected with HCV, significant fibrosis （METAVI≥F2） rate was 26.4% （103/390） and cirrhosis （METAVIR=F4） rate was 14.6% （57/390）. The therapy rate for HCV infeetion by recommendation （IFN/Peg-IFN and RBV） and DAAs was 6.7% （26/390）. The multivariate logistic regression model showed that factors were significantly associated with liver fibrosis including drink （OR=2.2, 95%CI： 1.2-4.2）, drug using time （OR=7.3, 95%CI=1.4-37.5）, and HIV-HCV coinfection （OR=0.4, 95%CI：0. 20.7）. Conclusion The HCV antibody positive rate in the five MMT clinics is higher among drug users. The therapy rate by recommendation or DAAs is low. It is important to expand knowledge on reducing the drink and drug using time, and to provide them with access to treatment in time so as to decrease the progression of liver fibrosis.