CAJ | 학술논문

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.
목적 료해운남성덕굉주미사동유지치료(MMT)취진자중병형간염병독(HCV)신발감염솔급기위험인소.방법 장2005년6월지2012년3월덕굉주소유입조MMT차HCV검측음성적해락인성은자작위연구대상,관찰기HCV양전정황,계산HCV신발감염솔병운용Cox비례풍험회귀모형분석기영향인소.결과 공2390명대상부합대렬납입표준.기중731인(30.6％)입조MMT후미접수수방검측；1659인(69.4％)접수과지소일차수방검측,루계수방관찰3509.13인년,기간99인발생HCV항체양전,HCV신발감염솔위2.82/100인년.2006-2011년HCV신발감염솔의차위3.62/100인년、5.36/100인년、6.71/100인년、2.56/100인년、1.90/100인년화0.44/100인년.운용Cox비례풍험모형다인소분석현시,재공제혼잡인소적영향후,대업/무업、입조전증주사독품、입조시HIV검측학인양성자재MMT치료기간신발HCV감염풍험현저고우농민、입조전미주사독품화입조시HIV검측음성자(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).결론 덕굉주MMT취진자중HCV신발감염솔자2009년기축년하강,단직업위대업/무업、입조전증주사독품화HIV감염자기HCV신발감염적풍험교고.
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.