乙型肝炎病毒合并人获得性免疫缺陷病毒混合感染后患者的长期随访研究  

Long term follow-up study of patients infected by hepatitis C virus combined with human immunodeficiency virus

作　　者：姬艳芳[1] 郗园林[1] 其木格[1] 鲁凤民[2] 沈弢[2] 张卫东[1] 

机构地区：[1]郑州大学公共卫生学院流行病学教研室,河南郑州450001 [2]北京大学医学部病原生物学系,北京100871

出　　处：《现代预防医学》2014年第13期2460-2462,2472,共4页Modern Preventive Medicine

基　　金：国家"十一五"科技重大专项课题基金资助项目(2008ZX10002-013)

摘　　要：目的了解丙型肝炎病毒/人类免疫缺陷病毒(HCV/HIV)混合感染患者、单纯HCV感染者的肝脏纤维化发生状况、生化指标改变和生存状况。方法对河南省某村有偿献血感染丙肝和丙肝/艾滋病混合感染患者176例进行肝功能和B超检查;统计三年间死亡发生例数。结合2009年8月第一次随访的资料,进行对比分析。进行KaplanMeier生存分析,得到两种感染类型患者从感染到死亡的中位死亡时间。结果混合感染组肝脏纤维化发生率高于单纯HCV感染组(χ2=11.53,P=0.001)。2012年单纯HCV感染组发生率高于2009年发生率(χ2=22.17,P=0.000),HCV/HIV混合感染组发生率也升高(χ2=4.440,P=0.035)。混合感染组的血清肝功能指标中,GGT、AST、ALT、TBILI、ALB和TP含量比第一次随访时均降低,DBILI升高,GGT水平改变无统计学差异;单纯HCV感染组中ALP、AST、ALT、ALBH和TP均降低,GGT和DBILI水平升高,TBILI水平改变无统计学差异。ALP感染到死亡的中位死亡时间两组不同(χ2=14.74,P=0.001),单纯HCV组感染后至死亡的时间长于混合感染组。结论HIV感染可能是加快单纯HCV感染病人肝脏纤维化和死亡的危险因素。Objective To analyze the survival status and liver function indexes of the patients infected with human immunodeficiency virus（HIV） combined with hepatitis C virus（HCV） and the patients only infected with HCV. Methods A village in Henan Province was selected as the investigation field, and a total of 176 patients were selected, including the patients infected with HIV combined with HCV and the patients only infected with HCV. The survival rate and liver function of them were followed up for three years, which were compared with the first follow-up data on August in 2009. We set up Kaplan-Meier test to analyze the survival time of patients with different infections. Results The incidence rate of liver fibrosis of the HCV/HIV patients was higher than that of the HCV patients（χ2=11.53, P=0.001）. The incidence rates of liver fibrosis in the two groups, the HCV group（χ2=22.17, P=0.000）and the HCV/HIV group（χ2=4.440, P=0.035）, were both higher than that of date in 2009. The levels of GGT, AST, ALT, TBILI,ALB and TP of the HIV/HCV patients were lower than those of the data in 2009, DBILI was higher, and GGT was constant. The levels of ALP, AST, ALT, ALBH and TP of the HCV patients were lower than those of the data in 2009, GGT and DBILI were higher,and TBILI was constant. The time from the infection to death in the two groups were different（χ2=14.74, P=0.001）; The time from the infection to death in the HCV group was longer than that of the HIV/HCV group. Conclusion The infection of HIV could be a risk factor of liver fibrosis and could accelerate the death.

关 键 词：丙型肝炎病毒(HCV) 人类免疫缺陷病毒(HIV) 混合感染 随访 

分 类 号：R184[医药卫生—流行病学]