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目的了解社区美沙酮维持治疗(MMT)门诊服药人员丙型肝炎病毒(HCV)的感染状况,以及感染者肝纤维化的进展程度,并分析其影响因素。方法 2016年8-9月在云南和甘肃5所MMT门诊,收集服药人员的HCV感染状况,并招募部分抗-HCV阳性者进行横断面研究,收集血样,计算APRI和FIB4以评估其肝纤维化程度,并调查其人口学特征、行为习惯、治疗情况以及艾滋病病毒(HIV)/HCV合并感染状况等。结果 5所MMT门诊在治人数合计2 343例,抗-HCV阳性868例(37.0%),HIV抗体阳性150例(6.4%),HIV/HCV合并感染138例(5.9%)。招募390例抗-HCV阳性服药人员为研究对象。其中103例(占26.4%)为肝纤维化程度F2期以上,57例为F4期,占14.6%。接受HCV抗病毒治疗者占13.3%(52/390)。采用HCV标准抗病毒治疗者中,用干扰素或长效干扰素者26例,用干扰素或长效干扰素联合利巴韦林的22例,用小分子药物的4例。多因素Logistic回归分析结果显示,饮酒2~4次/周[比值比(OR)=2.2,95%可信区间CI:1.2~4.2]、吸毒时间≥30年(OR=7.3,95%CI:1.4~37.5)、合并HIV感染(OR=0.4,95%CI:0.2~0.7)是肝纤维化进展的影响因素。结论 MMT门诊服药人员HCV感染率较高,实际接受HCV标准抗病毒治疗的比例偏低。饮酒、吸毒时间、合并HIV感染对肝纤维化的进展程度有重要的影响,应加强门诊工作人员的能力建设,使之能更好地对HCV感染者提供宣传教育、咨询及治疗服务。
Objective To understand the status of hepatitis C virus (HCV) infection in community methadone maintenance treatment (MMT) outpatients as well as the degree of progression of liver fibrosis in infected patients and to analyze its influencing factors. Methods From August to September 2016, five MMT clinics in Yunnan and Gansu were recruited to collect HCV infection status of drug users and to select some anti-HCV positive patients for cross-sectional study. Blood samples were collected and APRI and FIB4 were calculated to evaluate their liver fibrosis And investigate demographic characteristics, behavior, treatment, and HIV / HCV co-infection status. Results A total of 2 343 patients were treated in MMT clinics, 868 (37.0%) were positive for anti-HCV, 150 (6.4%) were HIV positive, and 138 (5.9%) were HIV / HCV co-infected. 390 cases of anti-HCV positive drug taking staff as the research object. Among them, 103 cases (26.4%) had more than F2 stage of liver fibrosis and 57 cases were F4 stage (14.6%). Patients receiving HCV antiviral therapy accounted for 13.3% (52/390). In the HCV standard antiviral treatment, interferon or long-acting interferon in 26 cases, with interferon or long-acting interferon combined with ribavirin in 22 cases, with small molecule drugs in 4 cases. Multivariate logistic regression analysis showed that the odds ratio (OR) was 2.2 to 95% CI 1.2 to 4.2, and the drug addiction time was 30 years (odds ratio 7.3, 95% CI: 1.4 ~ 37.5), combined with HIV infection (OR = 0.4,95% CI: 0.2 ~ 0.7) is the influencing factor in the progression of hepatic fibrosis. Conclusion The prevalence of HCV infection in MMT outpatients is relatively high, and the actual proportion receiving HCV standard antiviral therapy is low. Alcohol consumption, drug use time and HIV infection have a significant impact on the progress of liver fibrosis. The capacity building of outpatient staff should be strengthened so that they can better provide publicity, education, counseling and treatment services for HCV infection.