强制戒毒人员丙型肝炎病毒基因型对丙氨酸氨基转移酶的影响

The genotype of hepatitis C virus and its relationship with serum level of alanine aminotransferase among drug users in the compulsory detoxification center

目的了解强制戒毒人群中丙型肝炎病毒(hepatitis C virus,HCV)基因分型及其对丙氨酸氨基转移酶(alanine aminotransferase,ALT)的影响。方法连续抽取2016年5~7月上海市强制隔离戒毒所首次接受戒毒治疗、并有静脉注射史的所有对象。采用ELISA方法进行HCV抗体筛查和巢式RT-PCR进行血清HCV RNA的测定,PCR结果阳性者作为本研究对象,通过问卷调查了解HCV阳性对象的人口学和行为学特征,将纳入对象进行基因分型和血清ALT检测,初步了解该人群中HCV基因分型对ALT的影响。结果 210例HCV阳性对象被纳入。共分离到4种基因型和9种基因亚型,其中基因型别以3型为主(38.57%)。HCV基因亚型以6a (21.90%),3a (21.43%)和1b (19.05%)为主;同时存在1a、2a、2b、3b、6n和6e。210例研究对象中ALT异常率为27.14%,男性(32.67%)高于女性(13.33%);感染3型的患者ALT异常率为43.21%,高于其他型别的异常率,差异有统计学意义(χ~2=17.673,P=0.001);感染3型的患者ALT几何均数为34.6,高于其他型别的几何均数,差异有统计学意义(U=19.248,P=0.000)。多因素logistic回归结果显示男性(OR=2.56)、基因型3 (OR3∶1=3.17;OR3∶6=3.59)是ALT异常的主要危险因素。结论基因型3,6和1型为强制戒毒HCV感染者的优势基因,3型和1型对该人群肝功能的损伤发挥重要作用。

Objective To understand the genotype of Hepatitis C virus （HCV） and its relationship with serum level of alanine aminotransferase （ALT） among drug users （DUs） in a compulsory detoxification center, and to provide the evidence for clinical treatment. Methods A cross-sectional survey was conducted among 201 subjects admitted into Shanghai compulsory detoxification center due to injected drug abusing with HCV positive confirmed by FI.ISA and RT PCR from May to July, 2016. The demographic and behavioral characteristics were acquired by a questionnaire assisted interview, the serum level of ALT was measured and HCV genotype was determined. Results A total of 4 HCV genotypes and 9 subtypes were identified among 210 DUs with genotype 3 （38.57%） and subtype 6a （21.90%）, 3a （21.43%） and lb （19.05%） predominant. The overall abnormal rate of AI.T was 27.14%, which was higher in male than in female subjects （32.67% vs 13.33% ）. The highest ALT abnormal rate of 43.21% was found in DUs with genotype 3 （χ^2= 17. 673, P= 0. 001）. HCV infection and the GMs of ALT value was 34.6, significantly higher than others （U=19.248, P= 0. 000）. Multi-variant logistic regression analysis showed that male （OR = 2.56, 95% CI： 1.06-6.22） and genotype3 HCV infection （OR 3.17, 95~CI： 1.37 7.31） were the risk factors of ALT abnormality. Conclusions Genotype 3, 6 and 1 are the predominant genotypes of HCV in DUs, and genotype 3 HCV plays important role in liver function damage.