有注射毒品史人群的肝脏硬度和相关危险因素：一项前瞻性队列研究。

Liver stiffness and associated risk factors among people with a history of injecting drugs: a prospective cohort study.

机构信息

Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

出版信息

Subst Abuse Treat Prev Policy. 2024 Mar 26;19(1):21. doi: 10.1186/s13011-024-00603-z.

DOI:10.1186/s13011-024-00603-z

PMID:38532435

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10964694/

Abstract

BACKGROUND

Persons with opioid use disorders (OUD) and persons with substance use disorders (SUD) who inject substances have a reduced life expectancy of up to 25 years compared with the general population. Chronic liver diseases are a substantial cause of this. Screening strategies based on liver stiffness measurements (LSM) may facilitate early detection, timely intervention, and treatment of liver disease. This study aims to investigate the extent of chronic liver disease measured with transient elastography and the association between LSM and various risk factors, including substance use patterns, hepatitis C virus (HCV) infection, alcohol use, body mass index, age, type 2 diabetes mellitus, and high-density lipoprotein (HDL) cholesterol among people with OUD or with SUD who inject substances.

METHODS

Data was collected from May 2017 to March 2022 in a cohort of 676 persons from Western Norway. The cohort was recruited from two populations: Persons receiving opioid agonist therapy (OAT) (81% of the sample) or persons with SUD injecting substances but not receiving OAT. All participants were assessed at least once with transient elastography. A linear mixed model was performed to assess the impact of risk factors such as HCV infection, alcohol use, lifestyle-associated factors, and substance use on liver stiffness at baseline and over time. Baseline was defined as the time of the first liver stiffness measurement. The results are presented as coefficients (in kilopascal (kPa)) with 95% confidence intervals (CI).

RESULTS

At baseline, 12% (n = 83) of the study sample had LSM suggestive of advanced chronic liver disease (LSM ≥ 10 kPa). Advanced age (1.0 kPa per 10 years increments, 95% CI: 0.68;1.3), at least weekly alcohol use (1.3, 0.47;2.1), HCV infection (1.2, 0.55;1.9), low HDL cholesterol level (1.4, 0.64;2.2), and higher body mass index (0.25 per increasing unit, 0.17;0.32) were all significantly associated with higher LSM at baseline. Compared with persistent chronic HCV infection, a resolved HCV infection predicted a yearly reduction of LSM (-0.73, -1.3;-0.21) from baseline to the following liver stiffness measurement.

CONCLUSIONS

More than one-tenth of the participants in this study had LSM suggestive of advanced chronic liver disease. It underscores the need for addressing HCV infection and reducing lifestyle-related liver risk factors, such as metabolic health factors and alcohol consumption, to prevent the advancement of liver fibrosis or cirrhosis in this particular population.

摘要

背景

与普通人群相比，患有阿片类药物使用障碍（OUD）和物质使用障碍（SUD）且注射物质的人预期寿命缩短了多达 25 年。慢性肝病是造成这种情况的一个重要原因。基于肝硬度测量（LSM）的筛查策略可能有助于早期发现、及时干预和治疗肝病。本研究旨在调查使用瞬态弹性成像测量的慢性肝病的程度，以及 LSM 与各种风险因素之间的关联，包括物质使用模式、丙型肝炎病毒（HCV）感染、酒精使用、体重指数、年龄、2 型糖尿病和高密度脂蛋白（HDL）胆固醇，在 OUD 或有 SUD 且注射物质的人群中。

方法

本研究的数据于 2017 年 5 月至 2022 年 3 月从挪威西部的一个 676 人的队列中收集。该队列由两类人群招募：接受阿片类药物激动剂治疗（OAT）的人群（样本的 81%）或未接受 OAT 但有 SUD 且注射物质的人群。所有参与者均至少接受过一次瞬态弹性成像检查。使用线性混合模型评估 HCV 感染、酒精使用、与生活方式相关的因素和物质使用等风险因素对基线和随时间推移的肝硬度的影响。基线定义为第一次肝硬度测量的时间。结果以千帕斯卡（kPa）为单位呈现，带有 95%置信区间（CI）。

结果

在基线时，研究样本中有 12%（n=83）的人 LSM 提示存在晚期慢性肝病（LSM≥10kPa）。年龄较大（每增加 10 岁增加 1.0kPa，95%CI：0.68；1.3）、每周至少饮酒一次（1.3，0.47；2.1）、HCV 感染（1.2，0.55；1.9）、低 HDL 胆固醇水平（1.4，0.64；2.2）和较高的体重指数（每增加一个单位增加 0.25，0.17；0.32）均与基线时较高的 LSM 显著相关。与持续慢性 HCV 感染相比，已解决的 HCV 感染预测 LSM 从基线到随后的肝硬度测量每年减少（-0.73，-1.3；-0.21）。