恩替卡韦治疗合并非酒精性脂肪肝的慢性乙型肝炎临床疗效观察  

The clinical therapy efficacy of entecavir in patients with nonalcoholic fatty liver and chronic hepatitis B

作　　者：王浩[1] 常彩芳[1] 范敬静[1] WANG Hao;CHANG Cai-fang;FAN Jing-jing(Department of Infectious Diseases,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院感染科

出　　处：《中国中西医结合消化杂志》2019年第12期897-901,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：北京医卫健康公益基金会医学科学研究基金资助项目(No:B17738)

摘　　要：[目的]探讨非酒精性脂肪肝(NAFLD)对恩替卡韦(ETV)治疗慢性乙型肝炎(CHB)临床疗效的影响。[方法]纳入乙型肝炎病毒e抗原(HBeAg)阳性CHB患者273例,按是否合并NAFLD分为2组,其中合并NAFLD的CHB患者123例为观察组,单纯CHB患者150例为对照组。2组患者均予ETV抗病毒治疗至少72周,并行定期临床随访。[结果]在ETV治疗12周和24周时观察组患者的HBV-DNA清除率、HBeAg血清阴转率及谷丙转氨酶(ALT)复常率均显著低于对照组(P<0.05);在36周和48周时观察组患者的ALT复常率仍显著低于对照组(P<0.05),但2组间HBV-DNA清除率和HBeAg血清阴转率差异无统计学意义;在60周和72周时2组间的HBV-DNA清除率、HBeAg血清阴转率及ALT复常率差异均无统计学意义。Kaplan-Meier曲线示,观察组患者的HBV-DNA清除、HBeAg血清阴转及ALT复常均明显晚于对照组(P<0.05)。[结论]NAFLD既可影响ETV治疗CHB的病毒学、血清学及生物化学应答,又是ETV抗病毒获得病毒学和血清学应答基础上生物化学应答欠佳的重要原因,而延长ETV治疗疗程则有助于改善合并NAFLD的CHB患者的生物化学应答。[Objective]This study was aimed to investigate the effect of nonalcoholic fatty liver(NAFLD)on the clinical therapy efficacy of entecavir(ETV)in patients with chronic hepatitis B(CHB).[Methods]A total of 273 patients with hepatitis B e antigen(HBeAg)positive CHB were enrolled in this study,including observational group which consisted of 123 patients with CHB and NAFLD and control group which consisted of 150 patients with CHB.Both groups were received ETV antiviral treatment for at least 72 weeks and were completed the follow-up.[Results]At 12 and 24 weeks,the rates of HBV-DNA clearance,HBeAg seroconversion and ALT normalization were significantly lower in the observational group,compared with the control group(P<0.05).However,at 36 and 48 weeks,there was no significant difference in the rates of HBV-DNA clearance and HBeAg seroconversion between the groups,while the rate of ALT normalization was still lower in the observational group(P<0.05).At 60 and 72 weeks,there was no significant difference in the rates of HBV-DNA clearance,HBeAg seroconversion and ALT normalization between the two groups.Kaplan-Meier analyses revealed that the responses of HBV-DNA clearance,HBeAg seroconversion and ALT normalization in the observation group were later than the control group(P<0.05).[Conclusion]NAFLD could affect the virological,serological and biochemical responses of ETV antiviral treatment in patients with CHB,which also could be the major reason contributing to that CHB patients could achieve virological and serological responses,but poor biological response.And the extension of ETV treatment could be helpful for these patients with CHB and NAFLD.

关 键 词：非酒精性脂肪肝 恩替卡韦 乙型肝炎 

分 类 号：R575.1[医药卫生—消化系统]