本文關鍵詞： HCV 肝纖維化 美沙酮維持治療門診 吸毒人群　出處：《中國疾病預防控制中心》2017年碩士論文　論文類型：學位論文

【摘要】：目的:了解美沙酮維持治療(MMT)門診服藥人員丙型肝炎病毒(HCV)感染狀況及感染者的肝纖維化程度和治療需求,并探討影響HCV感染者肝纖維化的因素。方法:本研究于2016年8-10月在云南、廣西和甘肅三省的6所MMT門診進行橫斷面調(diào)查,首先了解門診服藥人員HCV、HIV感染狀況,再從中招募部分HCV抗體陽性服藥人員進一步開展研究,收集轉(zhuǎn)氨酶和年齡信息計算APRI和FIB4以評估其肝纖維化程度,并開展問卷調(diào)查收集其人口學特征、行為習慣、HCV相關治療情況以及HIV-HCV合并感染狀況等信息。結果:1.本研究的6所MMT門診服藥人員中,HCV抗體陽性率為48.5%(1438/2962),HIV 抗體陽性率為 9.7%(286/2962)。HIV-HCV 合并感染率為 9.0%(268/2962)。HCV抗體陽性者中HIV合并感染率為18.60%(268/1438),HIV抗體陽性者HCV合并感染率為93.7%(268/286)。2.本研究共招募652例MMT門診HCV抗體陽性服藥人員,調(diào)查對象的平均年齡為 43.6±7.1 歲,男性占 84.2%(549/652),漢族占 77.9%(508/652),初中及以下文化程度者占72.1%(470/652),已婚者占57.7%(376/652),待業(yè)或無業(yè)者占 56.6%(369/652),個人月均收入1000 元者占 56.9%(371/652)、≥2000元者占 26.1%(170/652)。3.調(diào)查對象中,吸毒年限以20～24年為主,占32.7%(213/652);曾靜脈注射吸毒者占84.4%(550/652);從未飲酒者占56.9%(371/652)。4.調(diào)查對象能正確回答所有丙型肝炎相關問題的為24.1%(157/652)。91.9%聽說過丙型肝炎,對其各種傳播途徑的知曉率均超過65%,對其危害的知曉率都在80%以上,對丙型肝炎能夠治愈的知曉率為52.3%。5.652例HCV抗體陽性服藥人員中,經(jīng)APRI和FIB4篩查75.9%(495/652)無肝纖維化,24.1%(157/652)有肝纖維化者,肝纖維化F2～F3期者占11.3%(74/652),F4 期者占 12.7%(83/652)。6.652例調(diào)查對象中25.9%(169/652)接受過丙型肝炎相關治療,10.0%(65/652)接受過丙型肝炎抗病毒治療;肝纖維化F0-F1期者24.6%(122/495)接受過丙型肝炎相關治療,10%(50/495)接受過抗病毒治療;F2-F3期者29.7%(占22/74)接受過丙型肝炎相關治療,12.2%(9/74)接受過抗病毒治療;F4期者30.1%(25/83)接受過丙型肝炎相關治療,7.2%(6/83)接受過抗病毒治療。7.單因素Logistic回歸分析中年齡≥40歲(0R=2.0,95%CI:1.3-3.1)、總是飲酒(OR=1.6,95%CI:1.0-2.5)是HCV感染者肝纖維化的相關影響因素。多因素Logistic回歸分析中吸毒年限≥30年(OR=6.5,95%CI:1.5-28.6)是HCV感染者肝纖維化的相關影響因素。結論:MMT門診服藥人員HCV感染率遠高于HIV感染率,有四分之一左右的HCV感染者不知曉自己的感染狀態(tài)。HCV感染者中出現(xiàn)肝纖維化并進行過抗病毒治療的比例低,需要優(yōu)先治療的人中,實際治療人數(shù)較少。吸毒年限等是HCV感染者肝纖維化發(fā)生的相關因素。建議加強MMT門診丙型肝炎相關知識的宣傳教育力度;進一步擴大HCV及其肝纖維化的檢測;并采取適當?shù)姆椒◣椭幦藛T降低甚至戒除毒品依賴。
[Abstract]:Objective: to investigate the status of hepatitis C virus (HCV) infection and the degree of hepatic fibrosis and the need for treatment of patients with methadone maintenance therapy (MMTM) outpatient. Methods: a cross-sectional investigation was conducted in 6 MMT outpatient clinics in Yunnan, Guangxi and Gansu from 2016 to October. First of all, to understand the HIV infection in outpatients, and then to recruit some HCV antibody positive drug users to carry out further research. Transaminase and age information were collected to calculate APRI and FIB4 in order to evaluate the degree of hepatic fibrosis. A questionnaire survey was conducted to collect their demographic characteristics and behavior habits. Results\\\ among the 6 MMT outpatients in this study, there were 6 drug users in MMT outpatient clinic. Results\\\%\%\%\%\%\%. The positive rate of HCV antibody was 48.5% 1438% 2962%. The positive rate of HIV antibody is 9. 7% 286 / 2962%. HIV-HCV coinfection rate is 9. 0% 268% 2962%). The co-infection rate of HIV was 18.60% / 1438% in HCV antibody positive patients. The co-infection rate of HCV in patients with positive HIV antibody was 93.7R / 2860.2. 652 HCV antibody positive drug users in MMT outpatient clinic were recruited in this study. The average age of the subjects was 43.6 鹵7.1 years old, 84.2% 549% 652% in males and 77.9% / 658% in Han nationality. 72.1% of the students with junior high school or lower education had 470% 652%, 57.7% of the married had 376% 652%, and 56.6% of the unemployed or unemployed had 369% 652%. The average monthly income of individuals was 1000 yuan, accounting for 56.9% 371R / 652N, and 26.1RMB / 6520.3. of the survey subjects. The number of years of drug abuse was mainly 20 ~ 24 years, accounting for 32.7% of 652%; Intravenous drug users accounted for 84.4% of the 550% 652%; The number of people who never drank was 56.9% 371r652k.4. the subjects who answered all the questions related to hepatitis C correctly were 24.11,157 / 652. 91.9% had heard of hepatitis C. The awareness of its various ways of transmission is over 65%, and the awareness rate of its harm is more than 80%. The rate of knowing that hepatitis C could be cured was 52.3% and 5.652 cases of HCV antibody positive drug users. Patients with hepatic fibrosis were screened by APRI and FIB4 (49.5% 652) without hepatic fibrosis 24.1kW 157R / 652). Hepatic fibrosis in F2F3 stage accounted for 11.3% (74% 652%). Patients with stage F4 accounted for 83.652 / 652 subjects who had received hepatitis C related treatment (25.9% 652 cases). (10.0% 65% 652) received antiviral therapy for hepatitis C; The patients with hepatic fibrosis in F0-F1 stage (24.62 / 495) received hepatitis C related treatment (10 / 50 / 495) and received antiviral therapy. The patients with stage F2-F3 (22 / 74) had received antiviral therapy. Patients with stage F4 (30.1 / 83) received hepatitis C related treatment. (7. 2 / 83) received antiviral therapy .7.The univariate Logistic regression analysis showed that the age 鈮，

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