慢性乙型肝炎合并非酒精性脂肪性肝病患者抗病毒治疗的疗效探讨

目的对慢性乙型肝炎（CHB）合并非酒精性脂肪性肝病（NAFLD）患者抗病毒治疗疗效进行回顾性分析,探讨肝细胞脂肪变是否影响CHB患者抗病毒的疗效。方法收集2004年1月至2011年12月在本院进行抗病毒治疗的110例CHB患者,CHB合并NAFLD患者99例,采用荧光定量PCR法检测血清HBV DNA水平,用化学发光法检测血清乙型肝炎两对半定量,采用全自动生物化学分析仪检测肝功能。计数资料采用χ2检验,计量资料采用t检验。结果 （1）干扰素抗病毒治疗时,24周单纯CHB患者较合并脂肪肝患者生化学应答率更高（χ2=4.069,P=0.044）;48周HBV DNA阴转率明显优于后者（χ2=17.327,P=0.000）。对于HBeAg阳性患者,单纯CHB患者在24周的生化学应答率、24和48周时的HBV DNA阴转率、HBeAg阴转率均显著优于合并脂肪肝患者,两者比较差异具有统计学意义（P〈0.05）,48周时两组的生化学应答差异无统计学意义（P〉0.05）。（2）核苷和核苷酸类药物抗病毒治疗时,48周单纯CHB患者的生化学应答率较高（χ2=7.620,P=0.006）,24和48周的HBV DNA阴转率差异无统计学意义。对于HBeAg阳性患者,24周时合并脂肪肝组患者的HBeAg转阴率高于单纯CHB患者,48周时ALT/AST复常率低于单纯CHB患者,差异均具有统计学意义（P〈0.05）,24周ALT/AST复常率、HBV DNA转阴率、48周HBV DNA转阴率、HBeAg转阴率差异均无统计学意义（P〉0.05）。结论肝细胞脂肪变对CHB患者的抗病毒治疗效果存在一定的影响。

Therapeutic effect of antiviral therapy in chronic hepatitis B patients with nonalcoholic fatty liver disease

Objective To retrospectively analyze the therapeutic effect of antiviral therapy in the chronic hepatitis B（CHB） patients with nonalcoholic fatty liver disease（NAFLD） and to investigate whether hepatocyte steatosis affects the response to antiviral therapy in CHB patients.Methods A total of 110 CHB patients and 99 CHB patients with NAFLD were enrolled in the study.Serum HBV DNA levels were measured by fluorescence quantitative PCR;serum HBsAg,HBsAb,HBeAg,HBeAb,and HBcAb were quantified by chemiluminescence;biochemical indices were determined by automatic biochemical analyzer to evaluate the liver function.Results（1） When receiving antiviral therapy with interferon,the CHB patients had a significantly higher rate of alanine aminotransferase（ALT）/aspartate aminotransferase（AST） normalization after 24 weeks of treatment（χ2=4.069,P=0.044） and a significantly higher rate of HBV DNA clearance after 48 weeks of treatment（χ2=17.327,P=0.000）,as compared with the CHB patients with NAFLD;in all HBeAg-positive patients,those with only CHB had a significantly higher rate of ALT/AST normalization after 24 weeks of treatment（P0.05） and significantly higher rates of HBV DNA clearance and HBeAg clearance after 24 and 48 weeks of treatment（P0.05）,as compared with those with CHB and NAFLD,but there was no significant difference in the rate of ALT/AST normalization between them after 48 weeks of treatment（P0.05）.（2） When receiving antiviral therapy with nucleos（t）ide analogues,the CHB patients had a significantly higher rate of ALT/AST normalization than the CHB patients with NAFLD after 48 weeks of treatment（χ2=7.620,P=0.006）,but there was no significant difference in the rate of HBV DNA clearance between them after 24 and 48 weeks of treatment（P0.05）;in all HBeAg-positive patients,those with CHB and NAFLD had a significantly higher rate of HBeAg clearance after 24 weeks of treatment（P0.05） and a significantly lower rate of ALT/AST normalization after 48 weeks of treatment（P0.05）,as compared with those with only CHB,but there were no significant differences in the rate of ALT/AST normalization after 24 weeks of treatment,rates of HBV DNA clearance after 24 and 48 weeks of treatment,and rate of HBeAg clearance after 48 weeks of treatment between them（P0.05）.Conclusion To some extent,hepatocyte steatosis affects the response to antiviral therapy in CHB patients.