上海市734例强制戒毒人员丙型病毒性肝炎感染影响因素和基因分型研究

Study on influencing factors and genotypes of hepatitis C virus infection among 734 drug users in Shanghai compulsory detoxification center

目的了解强制戒毒人群中丙型病毒性肝炎感染的影响因素和基因分型,为该人群的行为干预和临床治疗提供依据。方法采用横断面调查的方法,选择2015年5~7月间上海市强制隔离戒毒所首次接受戒毒治疗的吸毒对象为研究人群,通过问卷调查了解丙型肝炎病毒(hepatitis C virus,HCV)感染的影响因素,利用巢式逆转录聚合酶链反应(reverse transcription-polymerase chain reaction,RT-PCR)检测血清HCV RNA,并进行基因分型,了解HCV基因分型和地区分布特征。结果 734例强制戒毒人员中HCV RNA阳性者236例,阳性率为32.2%。采用多因素Logistic回归分析,结果显示毒品吸食年限(OR_(5~年)=2.79,95%CI:1.64~4.75;OR_(10~年)=9.37,95%CI:5.30~16.54;OR_(15~25年)=11.22,95%CI:6.26~20.01)、吸食海洛因(OR=2.02,95%CI:1.32~3.10)和曾经注射吸毒(OR=6.62,95%CI:4.41~9.94)是HCV感染的主要危险因素;文化程度为"大专及以上"是HCV感染的保护因素(OR=0.11,95%CI:0.02~0.63)。在236例HCV RNA阳性吸毒者中,HCV亚型以3a(24.1%)、6a(20.2%)、1b(19.5%)为主;同时存在3b、6n、1a、2a、2b和6e,地区分布总体较分散。结论毒品吸食年限、吸食海洛因和曾经注射吸毒仍然是强制戒毒人群中HCV感染的主要危险因素,基因分型以3a和6a为主。

Objective To understand the ildluencing factors and genotypes of hepatitis C virus infection among drug users in Shanghai compulsory detoxification center, so as to provide evidence for behavior intervention and clinical treatment. Methods A cross-sectional study was conducted with 734 drug users entering the detoxification center for the first addiction from May to July 2015. Field investigation was used to explore the influencing factors, and the nested reverse transcription-polymerase chain reaction （RT-PCR）was conducted to identify the genotype. The HCV genotype and the regional distribution characteristics were also investigated. Results HCV RNA in 235 of 734 drug addicts under compulsory rehabilitation were positive, and the positive rate was 32.2%. Muhivaliate unconditional Logistic regression analysis showed that the drug-use time （ OR5- year = 2. 79,95 % CI： 1.54-4. 75 ; OR10- year = 9.37, 95 % CI： 5.30-16. 54 ; 0R15_25 year = 11. 22 ,95% CI： 6. 25 - 20. 01 ） , heroin use （ OR = 2. 02,95% CI： 1.32-3.10） and injection drug-use （ OR = 5. 62,95% CI：4. 41-9.94） were risk factors of HCV infection. The education with college and above was the protective factor（ OR = 0. ll ,95% CI：O. 02-0. 53 ）. In 235 drug users with HCV RNA-positive, the predominant subtypes were 3a （24. 1% ）, 6a （20. 2% ）and lb（ 19.5% ） , meanwhile subtypes of 3b, 5n, la, 2a, 2b and 5e were also identified. Generally, the regional distribution of HCV genotype was disPerse. Conclusions Drug-use time, heroin use and injection drug-use are major risk factors of HCV infection, and the subtype of 3a and 6a are the predominant subtypes.