合并非酒精性脂肪性肝病对恩替卡韦治疗慢性乙型肝炎患者抗病毒疗效的影响

目的 探讨合并非酒精性脂肪性肝病(NAFLD)对慢性乙型肝炎(CHB)患者抗病毒治疗疗效的影响。方法 2015年1月～2019年1月我院诊治的HBeAg阳性的初治的CHB患者289例,其中合并NAFLD患者102例,未合并NAFLD患者187例。给予所有患者恩替卡韦治疗,观察96 w。结果 合并NAFLD患者体质指数为(26.1±2.7)kg/m²,显著高于CHB组【(22.5±2.4)kg/m²,P<0.05】,血尿酸水平为(405.1±125.8)μmol/L,显著高于CHB组【(324.6±96.8)μmol/L,P<0.05】,血清总胆固醇为(5.3±0.9 mmol/l,显著高于CHB组【(4.2±0.9)mmol/l,P<0.05】,血清甘油三酯水平为(3.5±0.7)mmol/l,显著高于CHB组【(1.9±0.5) mmol/l,P<0.05】,血清低密度脂蛋白水平为(3.4±1.0 mmol/l,显著高于CHB组【(2.3±0.8)mmol/l,P<0.05】,空腹血糖水平为(5.9±1.5)mmol/l,显著高于CHB组【(4.6±0.6) mmol/l,P<0.05】,而两组血清ALT水平(250.8±110.5 U/L对287.2±125.8 U/L)、AST水平(149.1±62.8 U/L对(168.7±70.8) U/L)、高密度脂蛋白水平(1.2±0.5 mmol/l对1.4±0.4mmol/l)和血清HBV DNA水平(6.8±1.2 lg copies/ml对6.9±1.1lg copies/ml)无显著性差异(P>0.05);在治疗48 w和96 w末,合并NAFLD组血清ALT复常率分别为69.6%和81.4%,显著低于CHB组(分别为80.2%和90.9%,P<0.05),而两组血清HBV DNA阴转率(分别为79.4%和87.3%对84.0%和90.9%)和血清HBeAg转阴率(分别为7.8%和7.8%对5.3%和5.9%)比较,无显著性差异(P>0.05)。结论 合并NAFLD可影响接受抗病毒治疗的CHB患者血生化学应答,其对组织学的影响及其对长期疗效的影响还有待于观察。

Impact of antiviral therapy efficacy of entecavir in patients with chronic hepatitis B and concomitant nonalcoholic fatty liver diseases

Objective The aim of this study was to investigate the impact of antiviral therapy efficacy of entecavir in patients with chronic hepatitis B(CHB)and concomitant nonalcoholic fatty liver diseases(NAFLD).Methods 289 naive serum HBeAg positive patients with CHB were enrolled in this study between January 2015 and January 2019,including 102 patients out of them with concomitant US-confirmed NAFLD.All patients received entecavir therapy and followed-up for 96 weeks.The biochemical,serologic and virological response were observed.Results The body mass index in patients with CHB and NAFLD was(26.1±2.7)kg/m 2,significantly higher than(22.5±2.4)kg/m²,P<0.05]in patients with CHB,serum uric acid l level was(405.1±125.8)μmol/L,significantly higher than(324.6±96.8)μmol/L,P<0.05]in patients with CHB,serum total cholesterol level was(5.3±0.9) mmol/l,significantly higher than(4.2±0.9)mmol/l,P<0.05]in patients with CHB,serum triglyceride level was(3.5±0.7)mmol/l,significantly higher than(1.9±0.5)mmol/l,P<0.05]in patients with CHB,serum low density lipoprotein level was(3.4±1.0)mmol/l,significantly higher than(2.3±0.8)mmol/l,P<0.05]in patients with CHB,and fasting blood glucose level was(5.9±1.5)mmol/l,significantly higher than(4.6±0.6)mmol/l,P<0.05]in patients with CHB,while there were no significant differences respect to serum alanine aminotransferase levels(ALT,250.8±110.5 U/L vs.287.2±125.8 U/L),serum aspartate aminotransferase level(149.1±62.8 U/L vs.(168.7±70.8)U/L),serum high density lipoprotein level(1.2±0.5 mmol/l vs.1.4±0.4 mmol/l)and serum HBV DNA load(6.8±1.2 lg copies/ml vs.6.9±1.1lg copies/ml)between the two groups(P>0.05);at the end of 48 week and 96 week treatment,serum ALT normalization rate in CHB patients with concomitant NAFLD were 69.6%and 81.4%,significantly lower than in patients with CHB(80.2%and 90.9%,respectively,P<0.05),while there were no significant differences respect to serum HBV DNA loss(79.4%and 87.3%vs.84.0%and 90.9%,respectively),and serum HBeAg negative rates(7.8%and 7.8%vs.5.3%and 5.9%)between the two groups(P>0.05).Conclusion The patients with CHB and concomitant NAFLD could poorly respond to entecavir antiviral therapy biochemically,and the impact on histological and long-term responses needs further investigation.