新疆伊宁市美沙酮维持治疗者丙肝感染就诊现况及影响因素

Treatment status and influence factors of HCV infection receiving methadone maintenance treatment in Yining City

目的了解新疆维吾尔自治区伊宁市美沙酮维持治疗者HCV感染现状、卫生服务利用情况并分析其影响因素。方法对伊宁市美沙酮维持治疗门诊18岁以上且抗-HCV阳性的在治者进行调查,内容包括人口学信息、丙肝认知、卫生服务利用情况。采集血样进行HCV-RNA、HIV-RNA定量检测和乙肝两对半检测;采用横断面调查和Logistic回归方法进行分析。结果共招募360例美沙酮维持治疗者,96.11%为男性;维吾尔族占87.50%;文化程度初中及以下者占82.22%;HCV-RNA阳性率87.22%,平均HCV-RNA(log10)为(5.30±2.23)IU/mL,HCV-RNA拷贝数≥10~5者占89.49%;HCV与HIV合并感染率为71.11%。26例因HCV感染到医院就诊,就诊率为7.22%,14例在就诊时接受了HCV-RNA检测;5例曾接受干扰素治疗。文化程度高中及以上(AOR=3.25,95%CI:1.24~8.55)、曾有HCV症状体征(AOR=6.67,95%CI:2.57~17.35)和丙肝知识认知良好(AOR=2.70,95%CI:1.12~6.53)是促进美沙酮门诊HCV感染服药人员就诊的因素。结论伊宁市美沙酮门诊感染HCV服药人员HCV病毒复制水平高,因HCV到医院就诊率低,需在美沙酮门诊加强丙肝相关咨询和宣教,促进HCV感染者及时寻求医疗卫生服务,减少疾病负担。

Objective To analyze the treatment status and influence factors of HCV infection receiving methadone maintenance treatment in Yining City. Methods An investigation for the adult MMT patients with anti-HCV positive receiving methadone maintenance treatment was conducted. Demographic information,knowledge of HCV and access to HCV clinic were collected from methadone maintenance treatment clinic. Blood samples were collected to perform HCV-RNA、HIV-RNA quantitative and HBV_M tests. Longitudinal survey and logistic regression method were applied to analyze the influence factors. Results A total of 360 participants were investigated,Male was 96. 11%,Uighur nationality was 87. 50%. Education at junior middle school or below was 82. 22%. HCV-RNA positive was 87. 22%. The average of HCV-RNA（ log10） was（ 5. 30 ± 2. 23） IU/ml. HCV-RNA copy number ≥10~5 was 89. 49%,combined infection rate of HCV with HIV was 71. 11%. 26（ 7. 22%） cases consulted medical service for HCV infection,14 cases received HCV-RNA test,5 cases received interferon therapy. It showed that the following three were positive factors for consulting HCV-related medical service： higher education level（ senior middle school or above）（ AOR = 3. 25,95% CI：1. 24 ~ 8. 55）,showing HCV-related symptoms and signs（ AOR = 6. 67,95% CI： 2. 57 ~ 17. 35）,and well understanding the knowledge of HCV（ AOR = 2. 70,95% CI： 1. 12 ~ 6. 53）. Conclusion The level of HCV virus replication among MMT patients in Yining was high,while the rate of receiving medical service was low. It is necessary to strengthen education and consultation of HCV in methadone clinic,promote HCV infection to consult medical service,and reduce disease caused burden.