富马酸丙酚替诺福韦治疗慢性乙型肝炎合并脂肪肝的疗效及安全性  

Efficacy and safety of tenofovir alafenamide fumarate in the treatment of CHB patients complicated with fatty liver disease

作　　者：卢嘉惠 张丛楠 何鹏园 欧梦党[1] 黄明星[1] LU Jia-hui;ZHANG Cong-nan;HE Peng-yuan;OU Meng-dang;HUANG Ming-xing(The Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院感染病防治中心,珠海519000

出　　处：《肝脏》2022年第8期858-862,867,共6页Chinese Hepatology

基　　金：广东省自然科学基金项目(2018A030313652);中山大学附属第五医院院内IIT资助项目(YNZZ2019-07)。

摘　　要：目的 研究富马酸丙酚替诺福韦治疗(TAF)慢性乙型肝炎合并脂肪肝疗效及安全性。方法 入组2019年6月至2020年9月期间中山大学附属第五医院诊治的慢性乙型肝炎合并脂肪肝患者共86例,分为初治组22例,经治组64例,比较两组患者用药前后各指标的差异。结果 初治组患者治疗48周后,HBV DNA未检出率和<20 IU/mL比例(50.0%比0.0%,22.7%比0.0%,P<0.001)高于基线,β2-微球蛋白(β2-MG,中位数1.82 mg/L比2.02 mg/L,P<0.001)及空腹血糖(中位数5.11 mmol/L比5.41 mmol/L,P<0.001)低于基线,差异有统计学意义。经治组患者治疗48周后,HBV DNA未检出率高于基线,>20 IU/mL比例低于基线(64.1%比39.1%,12.5%比35.9%,P=0.003),总胆固醇(TC,中位数4.71 mmol/L比4.00mmol/L,P<0.001)、甘油三酯(TG,中位数2.19 mmol/L比2.00mmol/L,P<0.001)、高密度脂蛋白胆固醇(HDL-C,中位数1.16 mmol/L比1.00mmol/L,P<0.001)高于基线,低密度脂蛋白胆固醇(LDL-C,中位数2.61 mmol/L比3.00mmol/L,P<0.001)及空腹血糖(中位数5.60 mmol/L比6.00mmol/L,P<0.001)低于基线,差异有统计学意义。结论 TAF无论在初治还是经治的慢性乙型肝炎合并脂肪肝患者中,均可获得较高的病毒学应答和生化学应答,且对肾功能影响小,但有使TCH、TG及HDL-C升高和空腹血糖降低的潜在作用。Objective To explore the efficacy and safety of tenofovir alafenamide fumarate(TAF)in the treatment of chronic hepatitis B(CHB)patients complicated with fatty liver disease.Methods A total of 86 patients with CHB and fatty liver disease diagnosed and treated in our hospital from June 2019 to September 2020 were enrolled.They were divided into a the treatment-naive group(22 cases)and a treatment-experienced group(64 cases).The clinical markers of 2 groups were compared at baseline and 48 weeks after treatment.Results After 48 weeks of treatment in treatment-naive group,the undetected rate and the ratio of hepatitis B virus(HBV)DNA less than 20 IU/mL(50.0%vs 0.0%,22.7%vs 0.0%,respectively,P<0.001)were higher than those at baseline.The levels of beta2-microglobulin(β2-MG)(median 1.82 mg/L vs 2.02 mg/L,P<0.001)and fasting blood glucose(median 5.11 mmol/L vs 5.41 mmol/L,P<0.001)at 48 weeks after treatment were lower than those at baseline,and the difference was statistically significant.In the treatment-experienced group,the undetected rate of HBV DNA at 48 weeks after treatment was higher than that at baseline,and the rate of HBV DNA more than 20 IU/mL at 48 weeks after treatment was lower than that at the baseline(64.1%vs 39.1%,12.5%vs 35.9%,respectively,P=0.003);Total cholesterol(TC)(median 4.71 mmol/L vs 4.00 mmol/L,P<0.001),triglyceride(TG)(median 2.19 mmol/L vs 2.00 mmol/L,P<0.001),high-density lipoproteincholesterol(HDL-C)(median 1.16 mmol/L vs 1.00 mmol/L,P<0.001)at 48 weeks after treatment were higher than those at baseline,low-density lipoprotein cholesterol(LDL-C)(median 2.61 mmol/L vs 3.00 mmol/L,P<0.001)and fasting blood glucose at 48 weeks after treatment(median 5.60 mmol/L vs 6.00 mmol/L,P<0.001)were lower than those at baseline,the differences were statistically significant.Conclusion CHB patients complicated with fatty liver disease in treatment-naive and treatment-experienced group can achieve higher virological and biochemical responses after treated with TAF,and the renal impairment of TAF is lowe

关 键 词：富马酸丙酚替诺福韦 慢性乙型肝炎 非酒精性脂肪性肝病 疗效 肾功能 

分 类 号：R575[医药卫生—消化系统] R512.62[医药卫生—内科学]