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Hepatology:DAA治疗时期,有精神健康或物质使用障碍的患者是否有机会接受丙型肝炎病毒治疗?

2018-07-30 MedSci MedSci原创

DAA药物问世后,接受治疗的丙型肝炎患者数量有所增加,特别是在存在肝脏相关并发症的患者中,但在接受治疗的可能性方面,MH/SUD患者仍存在差异。

研究背景:针对丙型肝炎病毒(HCV)的直接作用抗病毒药物(DAA)于2014年问世,但精神健康或物质使用障碍(MH/SUD)在获得治疗方面的作用尚不清楚。本研究的目的是在美国4个大型、多样化的医疗机构中,探讨HCV在DAA药物治疗前和DAA药物治疗后的范围和预测因素。

研究方法:回顾性分析了29544例慢性丙型肝炎患者在1/11-2/28/17间接受或未接受治疗的数据。采用Kaplan Meier曲线检验经MH/SUD分层处理的丙型肝炎病毒累积风险。采用多变量广义估计方程(GEE)和改进的泊松模型分析了DAA药物治疗前(1/ 11-12/31/13)和DAA药物治疗后(1/1/14-2/28/17)的队列中丙型肝炎病毒治疗的预测因子。

研究结果:总的来说,DAA药物问世后,有21.7%(2,879/13,240)的慢性丙型肝炎患者接受了治疗,而DAA药物问世之前的治疗比例为3.5%(574/ 16304)。与非西班牙裔白人相比,西班牙裔白人(AOR 0.36, 95% CI: 0.25, 0.52)在DAA药物问世后不太可能接受治疗。并发非酒精性脂肪性肝病(AOR 1.39, 95% CI: 1.05, 1.83)、肝硬化(AOR 2.00, 95% CI:1.74, 2.31)和肝移植(AOR 2.72, 95% CI: 1.87, 3.94)的患者在DAA药物问世后,更容易接受治疗。在DAA药物问世之前(AOR 0.46, 95% CI: 0.36, 0.60)和之后(AOR 0.63, 95% CI: 0.55, 0.71),MH/SUD患者治疗的可能性都较小。总的来说,2011-17年期间接受HCV治疗的MH/SUD患者与未接受治疗的MH/SUD患者的累积风险分别为13.6%和21.6% (P <0.001)。

研究结论:DAA药物问世后,接受治疗的丙型肝炎患者数量有所增加,特别是在存在肝脏相关并发症的患者中,但在接受治疗的可能性方面,MH/SUD患者仍存在差异。

原始出处:

Jain MK, Thamer M, Therapondos G, et al. Has Access to HCV Therapy Changed for Patients with Mental Health or Substance Use Disorders in the DAA Period? Hepatology, 2018, Jul 17. doi: 10.1002/hep.30171.

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    2018-08-01 qingting
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    2018-08-01 gwc384
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