德宏州2012-2016年美沙酮维持治疗者HCV抗体阳转率及其影响因素

Risk factors of HCV seroconversion rate among drug users receiving methadone maintenance treatment during 2012 to 2016 in Dehong prefecture,Yunnan province

目的了解云南省德宏州美沙酮维持治疗（MMT）的海洛因成瘾者在2012-2016年期间丙型肝炎病毒（HCV）抗体阳转率及其相关因素。方法以在德宏州MMT门诊维持治疗的HCV抗体检测阴性的海洛因成瘾者作为研究对象,计算2012-2016年每年的HCV抗体阳转率,并运用Logistics回归模型分析影响HCV阳转的可能相关因素。结果 2012-2016年,在德宏州MMT门诊维持治疗且入组时HCV检测阴性者共3 471人,期间失访613人（17.7%）。截至2016年底,该队列累计随访2 858人,HCV抗体阳转者133人,各年HCV抗体阳转率依次分别为2.20%、2.23%、1.86%、1.25%、0.60%。多因素Logistics回归分析显示,在控制了混杂因素影响后,入组前注射吸毒者[比值比（OR）=6.54;95%可信区间（CI）：4.13~10.34]、最近一次尿检阳性（OR=1.67;95%CI：1.14~2.43）、吸毒时间≥10年者（OR=1.65;95%CI：1.04~2.62）,HCV抗体阳转率显著高于入组前没有注射吸毒史者、最近一次尿检阴性者、吸毒时间〈10年者;入组时≥50岁者（OR=0.35;95%CI：0.14~0.90）、职业为其他者（OR=0.26;95%CI：0.10~0.67）HCV抗体阳转率分别低于入组时〈30岁者和农民,差异均有统计学意义（P〈0.05）。结论德宏州MMT门诊就诊者的HCV抗体阳转率从2012年起逐年降低;入组时〈30岁、农民、入组前有注射吸毒史、最近一次尿检阳性、吸毒时间≥10年者发生HCV抗体阳转的风险更高。

Objective To investigate HCV seroconversion rate from 2012 to 2016 and analyze the risk factors of HCV infection among those receiving methadone maintenance treatment（MMT）in Dehong prefecture,Yunnan province.Methods The study enrolled all heroin addicts with hepatitis C virus（HCV）antibody negative in MMT clinics.And the risk factors of HCV infection were analyzed by logistics regression model.Results A total of 6160 heroin addicts receiving MMT from 2012 to 2016,among whom 3471 cases were tested HCV negative in the cohort study since enrollment in 2012.By the end of 2016,a total of 2858 cases were followed up,with 613 cases lost and 133 infected with HCV.The HCV seroconversion rate in each year were 2.20%,2.23%,1.86%,1.25% and 0.60% respectively.According to the logistics regression model,multivariate analyses showed that the risk factors of HCV infection included a history of injecting drugs before enrollment,the last urine test as positive,drug addiction time more than 10 years,with the difference between all the factors statistically significant（OR=6.54;OR=1.67;OR=1.65）.The HCV seroconversion rate of those who were not farmers and over 50 years old were both significantly lower than that of famers and those less than 30 years old（OR=0.26;OR=0.35）.All the difference was statistically significant（P0.05）.ConclusionThe HCV seroconversion rate of those receiving MMT in Dehong prefecture is decreasing year by year since 2012.Those aged30 years,famers,with a history of injecting drug use before enrollment,the last urine test as positive and drug addiction for 10 years have greater risks of HCV seroconversion.