慢性丙型肝炎吸毒者的胆总管扩张与当前使用美沙酮有关。

Common bile duct dilatation in drug users with chronic hepatitis C is associated with current methadone use.

机构信息

From the Department of Research (SJL, BPXG, CEAL, MP), Cluster Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; Center of Infectious Diseases and Immunology Amsterdam (BPXG, CEAL, MP) and Department of Gastroenterology and Hepatology (UB, CJW), Academic Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine (MP), Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands.

出版信息

J Addict Med. 2014 Jan-Feb;8(1):53-8. doi: 10.1097/ADM.0000000000000006.

DOI:10.1097/ADM.0000000000000006

PMID:24394497

Abstract

OBJECTIVES

Dilatation of the common bile duct (CBD) can be an ominous sign for malignancy of the pancreatobiliary tract; however, it has also been described as a presumably harmless side effect of opioid use. We investigated the prevalence and determinants of CBD dilatation among drug users receiving methadone maintenance therapy in the Netherlands.

METHODS

A cross-sectional study was conducted in a prospectively studied and well-defined cohort of drug users with chronic hepatitis C virus infection, attending the Public Health Service of Amsterdam, the Netherlands. Patients underwent abdominal ultrasonography as part of pretreatment screening. A multivariable logistic regression model was used to analyze potential demographic and drug use-related determinants of radiological CBD dilatation.

RESULTS

Between September 2004 and December 2011, 222 hepatitis C virus-infected drug users were evaluated. Dilatation of the CBD was found in 50 of 222 patients (22.5%), with a median diameter of 8.0 mm (interquartile range, 7.0 to 10.0; n = 43). Dilatation was associated with current use of methadone (adjusted odds ratio = 20.50; 95% confidence interval, 2.79 to 2.61 × 10(3)), independent of the current methadone dose, and with age per 10-year increase (adjusted odds ratio = 1.68; 95% confidence interval, 1.06 to 2.71). Regular use of heroin in the 6 months before ultrasonography was not found to be associated with dilatation.

CONCLUSIONS

Dilatation of the CBD is common in drug users under methadone treatment and seems to be a harmless side effect of opioid agonists.

摘要

目的

胆总管（CBD）扩张可能是胰胆管恶性肿瘤的一个不祥征象；然而，它也被描述为阿片类药物使用的一种可能无害的副作用。我们调查了在荷兰接受美沙酮维持治疗的药物使用者中 CBD 扩张的患病率和决定因素。

方法

在一项前瞻性研究和明确定义的慢性丙型肝炎病毒感染药物使用者队列中进行了横断面研究，该队列在荷兰阿姆斯特丹公共卫生服务机构就诊。患者接受腹部超声检查作为预处理筛查的一部分。使用多变量逻辑回归模型分析与放射学 CBD 扩张相关的潜在人口统计学和药物使用相关决定因素。

结果

2004 年 9 月至 2011 年 12 月期间，评估了 222 名丙型肝炎病毒感染的药物使用者。在 222 名患者中发现 CBD 扩张 50 例（22.5%），CBD 直径中位数为 8.0 毫米（四分位距，7.0 至 10.0；n = 43）。扩张与当前使用美沙酮相关（调整后的优势比=20.50；95%置信区间，2.79 至 2.61×10（3）），与当前美沙酮剂量无关，与年龄每增加 10 岁相关（调整后的优势比=1.68；95%置信区间，1.06 至 2.71）。在超声检查前的 6 个月内，定期使用海洛因与扩张无关。