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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 understand the relationship between Hepatitis C virus (HCV) infection and liver damage in HIV-positive patients with methadone maintenance treatment in Dehong Prefecture of Yunnan Province. Methods The HIV-infected patients who had history of anti-virus in the population of methamphetamine maintenance treatment in Dehong were studied. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) in any indicator exceeds the upper limit of normal, that is identified as impaired liver function; aspartate aminotransferase - platelet index (APRI) as a cirrhosis index to analyze the relationship between HCV infection and liver damage in subjects before receiving antiviral therapy. Results A total of 663 subjects were enrolled, of whom 96.1% (637) were males, 57.3% (380) were males from 30-39 years, 41.8% (277) and 31.4% (208) Han, Dai and Jingpo respectively People) and 18.6% (123 people); 88.4% (586) were infected by intravenous drug use. The positive rate of HCV antibody was 87.3% (579); the positive rate of hepatitis B virus surface antigen (HBsAg) was 7.7% (51). The incidence of liver damage among HIV / HCV co-infected patients was higher: 63.2% (366/579) in liver damage and 25.0% (144/575) in cirrhosis. χ2 analysis showed that after excluding the influence of HBV, HCV positive and AST, ALT, impaired liver function, abnormal liver cirrhosis was significantly correlated. Multivariate analysis showed that the risk of impaired liver function in HCV-positive patients was 2.10-fold [95% confidence interval (CI): 1.28 to 3.43] for patients with negative liver cirrhosis and 2.59-fold greater for patients with HCV-positive cirrhosis (95% CI: 1.29-5.19). Also found that HBV-positive, male, older, minority, CD 4T lymphocyte count is the risk of liver damage. Conclusion Among HIV-positive patients treated with methadone, patients with positive HCV can easily lead to liver damage. Careful attention should be paid to their liver damage. Patients should be given HCV antiviral therapy if necessary.