慢性乙型肝炎合并脂肪肝对肝纤维化及抗病毒疗效的影响

目的：探讨慢性乙型肝炎（CHB）合并非酒精性脂肪性肝病（NAFLD）对阿德福韦酯抗病毒疗效及对肝纤维化的影响。方法：194例CHB患者分为合并NAFLD组（A组,73例）和未合并NAFLD组（B组,121例）,均给予阿德福韦酯（10 mg/d,1次/d）治疗52周。观察两组治疗前后肝功能、病毒学指标及肝纤维化指标的变化。结果：治疗后两组血清AST、ALT指标均显著下降,且B组下降幅度高于A组,差异有统计学意义（P〈0.05）;B组HBeAg阴转率、HBeAg转换率和HBV-DNA转阴率显著高于A组,差异有统计学意义（P〈0.05）;两组HA、LN、PCⅢ、CIV水平均较治疗前显著下降,且B组下降幅度高于A组,差异有统计学意义（P〈0.05）。结论：合并NAFLD影响CHB患者肝功能恢复和肝纤维化进展,也降低阿德福韦酯抗病毒治疗的应答效应。

Effect on Hepatic Fibrosis and Antiviral Therapy in Patients with Chronic Hepatitis B by Non Alcoholic Fatty Liver Disease

Objective： To explore the effect on antiviral efficacy of Adefovir Dipivoxil and liver fibrosis in patients with chronic hepatitis B （ CHB ） by nonalcoholic fatty liver disease （ NAFLD ） . Method： 194 cases of CHB were divided into NAFLD group （ group A, 73 cases ） and without NAFLD group （ group B, 121 cases ）, all were treated with Adefovir Dipivoxil （ 10 mg/d, lid ） for 52 weeks. The changes of liver function, HBV markers and liver fibrosis indexes before and after treatment were observed. Result： After treatment, the serum AST, ALT in the two groups were significantly decreased, and the decreased extent in the group B was higher than that in the group A （ P〈0.05 ） ; the HBeAg negative conversion rate, HBeAg conversion rate and HBV-DNA negative rate in the group B were significantly higher than that in the group A, the difference were statistically significant （ P〈0.05 ） ; the HA, LN, PC HI, CIV levels of two groups were significantly lower than before treatment, and the decreased extent in the group B was higher than that of the group A, the difference were statistically significant （ P〈0.05 ） . Conclusion： NAFLD has effects on the progress of liver function recovery and hepatic fibrosis in patients with CHB, and it also reduce the antiviral efficacy of Adefovir Dipivoxil.