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

段松; 韩晶; 唐仁海; 杨跃诚; 项丽芬; 叶润华; 杨顺生; 杨盈波; 龙玉存; 李国强; 尹棉松; 庞琳; 柔克明; 吴尊友; 何纳

Abstract

段松,韩晶,唐仁海,杨跃诚,项丽芬,叶润华,杨顺生,杨盈波,龙玉存,李国强,尹棉松,庞琳,柔克明,吴尊友,何纳.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[J].Chinese journal of Epidemiology,2013,34(6):552-556

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

Received:November 15, 2012 Revised:June 12, 2012

DOI：

KeyWord: 丙型肝炎病毒美沙酮维持治疗队列研究

English Key Word: Hepatitis C virus Methadone maintenance treatment Cohort study

FundProject:国家"十一五"科技重大专项

Author Name	Affiliation	E-mail
DUAN Song	Dehong Prefecture Center for Disease Control and Prevention(CDC),Luxi 678400, China	nhe@shmu.edu.cn
HAN Jing	Dehong Prefecture Center for Disease Control and Prevention(CDC),Luxi 678400, China
TANG Ren-hai	Chinese Center for AIDS and STD Control and Prevention, China CDC
YANG Yue-cheng	Dehong Prefecture Center for Disease Control and Prevention(CDC),Luxi 678400, China
XIANG Li-fen	Dehong Prefecture Center for Disease Control and Prevention(CDC),Luxi 678400, China
YE Run-hua	Dehong Prefecture Center for Disease Control and Prevention(CDC),Luxi 678400, China
YANG Shun-sheng	Mangshi City CDC
YANG Ying-bo	RuiliCity CDC
LONG Yu-cun	Longchuan County CDC
LI Guo-qiang	Yingjiang County CDC
YIN Mian-song	Lianghe County CDC
PANG Lin	Chinese Center for AIDS and STD Control and Prevention, China CDC
ROU Ke-ming	Chinese Center for AIDS and STD Control and Prevention, China CDC
WU Zun-you	Chinese Center for AIDS and STD Control and Prevention, China CDC
HE Na	Department of Epidemiology, School of Public Health, and Key Laboratory of Public Health Safety of Ministry of Education,Fudan University

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Abstract:

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.

English Abstract:

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.

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