摘要
目的了解云南省德宏州艾滋病病毒（HIV）阳性美沙酮维持治疗人群中,丙型肝炎病毒（HCV）感染与肝脏损伤的关系。方法以德宏州美沙酮维持治疗人群中有抗病毒史的HIV感染者为研究对象。以丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）中任一指标超过正常上限值,即认定为肝功能受损;以天冬氨酸氨基转移酶-血小板指数（APRI）作为肝硬化指数,分析研究对象在接受抗病毒治疗前HCV感染与肝脏损伤的关系。结果共纳入663名研究对象,其中男性占96.1%（637人）;30-39岁者占57.3%（380人）;汉族、傣族和景颇族分别占41.8%（277人）、31.4%（208人）和18.6%（123人）;静脉注射吸毒途径感染HIV者占88.4%（586人）。HCV抗体阳性率为87.3%（579人）;乙型肝炎病毒（HBV）表面抗原（HBsAg）阳性率为7.7%（51人）。HIV/HCV合并感染人群中发生肝脏损伤的比例较高：肝功能受损发生率为63.2%（366/579）,肝硬化发生率为25.0%（144/575）。χ2分析显示：在排除了HBV的影响后,HCV阳性与AST、ALT、肝功能受损、肝硬化发生异常显著相关。多因素分析显示：HCV阳性者发生肝功能受损的风险是阴性者的2.10倍[95%可信区间（CI）：1.28-3.43];HCV阳性者发生肝硬化的风险是阴性者的2.59倍（95%CI：1.29-5.19）。同时发现,HBV阳性、男性、年龄较大、少数民族、CD＋4T淋巴细胞数减少是发生肝脏损伤的危险因素。结论 HIV阳性美沙酮维持治疗人群中,HCV阳性易导致病人发生肝脏损伤,需要关注其肝脏损伤情况,有条件应给与针对HCV抗病毒治疗。
Objective To learn how Hepatitis C Virus（HCV）influences liver injury in Human Immunodeficiency Virus（HIV）patients who are receiving methadone maintenance treatment（MMT）in Dehong Prefecture,Yunnan Province.Methods The study uses the baseline information of HIV-positive patients receivingMMT and HIV ART.Liver dysfunction is defined as the status that either AST or ALT is abnormal.Aspartate Aminotransferaseto-Platelet Ratio Index（APRI）is used to judge the status of liver cirrhosis.The study analyzes the information to find relationship between HCV and liver injury.Results The study includes 663 patients,with 96.1% male;57.3% aged from 30 to 39;41.8%ethnic Han,31.4%ethnic Dai,and 18.6%ethnic Jingpo;88.4% were infected with HIV through intravenous drug use（IVDU）.Prevalence of HCVAb-positive and Hepatitis B Virus（HBV）HBsAg-positive is 87.3% and 7.7%. Among coinfected patients the prevalence of liver dysfunction and liver cirrhosis is 62.3%（66/579）and 25.0%（144/575）.After the effect of HBV was eliminated,HCV infection significantly increases the prevalence of ALT,AST,liver function and Aspartate Aminotransferaseto-Platelet Ratio Index（APRI）abnormality.Multiple logistic regression shows that HCV-positive patients have significantly higher prevalence of liver dysfunction（OR=2.10,95% confidence interval（CI）：1.28,3.43）,liver cirrhosis（OR=2.59,CI：1.29,5.19）.Meanwhile the study finds that HBV-positive,male,aged,ethnic minority,fewer CD4 cells are risk factors of liver injury.Conclusions HCV results in liver injury among HIV/HCV co-infected patients receiving MMT.The status of HCV infection and other liver injury risk factors should be considered before the HIV ART,and HCV ART should be provided if possible.
出处
《中国艾滋病性病》
CAS
北大核心
2015年第11期926-929,938,共5页
Chinese Journal of Aids & STD
基金
国家自然科学基金项目(81373062)~~
