云南省德宏州美沙酮维持治疗者丙型肝炎病毒新发感染率及影响因素研究  

Study on the incidence and risk factors of HCV infection among heroin addicts who were on methadone maintenance treatment in Dehong prefecture, Yunnan province

作　　者：段松[1] 韩晶[2] 唐仁海[1] 杨跃诚[1] 项丽芬[1] 叶润华[1] 杨顺生 杨盈波 龙王存[5] 李国强[6] 尹棉松[7] 庞琳[2] 柔克明[2] 吴尊友[2] 何纳[8] 

机构地区：[1]云南省德宏州疾病预防控制中心,潞西678400 [2]中国疾病预防控制中心性病艾滋病预防控制中心 [3]云南省芒市疾病预防控制中心 [4]瑞丽市疾病预防控制中心 [5]陇川县疾病预防控制中心 [6]盈江县疾病预防控制中心 [7]梁河县疾病预防控制中心 [8]复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室

出　　处：《中华流行病学杂志》2013年第6期552-556,共5页Chinese Journal of Epidemiology

基　　金：基金项目：国家“十一五”科技重大专项（2008ZXl0001-016）

摘　　要：目的 了解云南省德宏州美沙酮维持治疗（MMT）就诊者中丙型肝炎病毒（HCV）新发感染率及其危险因素.方法 将2005年6月至2012年3月德宏州所有入组MMT且HCV检测阴性的海洛因成瘾者作为研究对象,观察其HCV阳转情况,计算HCV新发感染率并运用Cox比例风险回归模型分析其影响因素.结果 共2390名对象符合队列纳入标准.其中731人（30.6％）入组MMT后未接受随访检测；1659人（69.4％）接受过至少一次随访检测,累计随访观察3509.13人年,期间99人发生HCV抗体阳转,HCV新发感染率为2.82/100人年.2006-2011年HCV新发感染率依次为3.62/100人年、5.36/100人年、6.71/100人年、2.56/100人年、1.90/100人年和0.44/100人年.运用Cox比例风险模型多因素分析显示,在控制混杂因素的影响后,待业/无业、入组前曾注射毒品、入组时HIV检测确认阳性者在MMT治疗期间新发HCV感染风险显著高于农民、入组前未注射毒品和入组时HIV检测阴性者（HR =2.02,95％CI：1.18 ～ 3.48；HR=9.05,95％CI：5.49 ～ 14.93；HR=2.12,95％CI：1.37 ～ 3.56）.结论 德宏州MMT就诊者中HCV新发感染率自2009年起逐年下降,但职业为待业/无业、入组前曾注射毒品和HIV感染者其HCV新发感染的风险较高.Objective To determine the incidence and risk factors of HCV infection among heroin addicts who were receiving methadone maintenance treatment （MMT） in Dehong prefecture,Yunnan province.Methods All heroin addicts who were HCV negative at the initiation of MMT in June 2005 through March 2012,in Dehong prefecture,were included in this cohort analysis.HCV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.Results A total of 2390 MMT clinic attendants were qualified for this cohort study by March 2012.731 （30.6%） of them had never received any follow-up HCV testing so were recognized as loss to follow-up.The other 1659 （69.4%） participants had received at least one follow-up HCV testing and were observed for a total of 3509.12 person-years （py）.During this period 99 new HCV infections or HCV sero-converters were identified.The overall HCV incidence was 2.82/ 100 py and was 3.62/100 py for 2006,5.36/100 py for 2007,6.71/100 py for 2008,2.56/100 py for 2009,1.90/100 py for 2010,and 0.44/100 py for 2011,respectively.Results from multiple regression analysis,using Cox proportional hazard model,indicated that after controlling for confounding variables,those who were unemployed,being injecting drug users （IDUs） or HIV positive at entry into the MMT program were more likely to be newly infected with HCV or HCV sero-converted during the follow-up period than those who were peasants,non-IDUs or HIV negative at entry into the MMT program （HR=2.02,95% CI：1.18-3.48; HR=9.05,95% CI：5.49-14.93; HR=2.12,95% CI：1.37-3.56）,respectively.Conclusion The incidence of HCV infection among MMT clinic attendants was decreasing since 2009 in Dehong prefecture.Those who were unemployed,injecting drug users and HIV positive were at higher risk of HCV infection.

关 键 词：丙型肝炎病毒 美沙酮维持治疗 队列研究 

分 类 号：R51[医药卫生—内科学] R74[医药卫生—临床医学]