Grando-Lemaire Véronique, Goisset Pierre, Sorge Frédéric, Trinchet Jean-Claude, Castera Laurent, Roulot Dominique, Sitruk Véronique, Beaugrand Michel
Service d'Hépato-Gastroentérologie, Hôpital Jean Verdier, Assistance publique-Hôpitaux de Paris, 93143 Bondy Cedex, France.
Gastroenterol Clin Biol. 2002 Dec;26(12):1091-6.
To investigate the feasibility and efficacy of hepatitis C virus screening in drug users in an addiction out-patient unit.
All patients followed in an addiction out-patient unit were asked to undergo anti-hepatitis C virus antibody testing; further evaluation and treatment if indicated, were offered to positive patients. When treatment was initiated (Metavir score >=F2), patients were followed-up both by the hepatologist and the out-patient unit physician.
Between July 1997 and September 2000, 404 consecutive patients (310 men, mean age: 32, alcohol intake >=50 g per day in 51%, 94% in opiate substitution program) were included. Sixty-six per cent (269/404) of patients agreed to undergo HCV antibodies testing: 84% had a positive test. 68% of these patients accepted ALT serum measurement and 120 had indications for liver biopsy. Eighty-eight liver biopsies were performed, showing severe fibrosis (Metavir score F3 or F4) in 20 cases (22%). Ethanol intake was significantly correlated to fibrosis (P<0.05). Antiviral treatment was indicated in 47 patients but was only initiated in 27 due to patient refusal (n=7) or contraindication (n=13). Treatment had to be discontinued in 12 cases because of psychiatric side effects (depression: n=3; delirium: n=3; severe irritability: n=3; relapse with heroin injection: n=3). Finally, only 5 patients were sustained responders.
Despite the high seroprevalence of HCV antibodies in this unit, the benefits of antiviral therapy are low due to high drop out rate. Ethanol withdrawal should be the highest priority in these patients.
探讨在戒毒门诊对吸毒者进行丙型肝炎病毒筛查的可行性和有效性。
要求在戒毒门诊接受治疗的所有患者进行抗丙型肝炎病毒抗体检测；对检测呈阳性的患者，如有指征则进行进一步评估和治疗。当开始治疗时（梅塔维评分>=F2），由肝病专家和门诊医生共同对患者进行随访。
1997年7月至2000年9月，纳入了404例连续患者（310例男性，平均年龄：32岁，51%的患者每日酒精摄入量>=50克，94%的患者参加阿片类药物替代治疗项目）。66%（269/404）的患者同意进行丙肝抗体检测：其中84%检测呈阳性。这些患者中有68%接受了谷丙转氨酶血清检测，120例有肝活检指征。共进行了88例肝活检，20例（22%）显示有严重纤维化（梅塔维评分F3或F4）。乙醇摄入量与纤维化显著相关（P<0.05）。47例患者有抗病毒治疗指征，但由于患者拒绝（n=7）或存在禁忌证（n=13），只有27例开始治疗。12例患者因精神副作用（抑郁：n=3；谵妄：n=3；严重易怒：n=3；海洛因注射复吸：n=3）而不得不停止治疗。最后，只有5例患者为持续应答者。
尽管该科室丙肝抗体血清阳性率很高，但由于高脱落率，抗病毒治疗的获益较低。在这些患者中，戒酒应是首要任务。
