多烯磷脂酰胆碱对慢性乙型肝炎并发非酒精性脂肪性肝病患者抗病毒疗效的影响

Clinical effect of polyene phosphatidyl choline on antiviral therapy of chronic hepatitis B complicated with non-alcoholic fatty liver disease

目的观察多烯磷脂酰胆碱对慢性乙型肝炎（CHB）并发非酒精性脂肪性肝病（NAFLD）患者的阿德福韦酯抗病毒疗效的影响，并探讨其相关机制。方法随机将47例患者分成治疗组及对照组。治疗组给予多烯磷脂酰胆碱联合阿德福韦酯治疗，对照组单用阿德福韦酯，观察两组治疗前后乙型肝炎病毒核酸（HBV DNA）定量、乙型肝炎病毒标志物（HBV-Maker）的变化及超声显示的脂肪肝改善情况。结果治疗组脂肪肝改善率、病毒应答率明显高于对照组，且治疗组的病毒应答率是对照组的4．58倍，差异均有统计学意义（P〈0．05）。结论多烯磷脂酰胆碱能明显提高CHB并发NAFLD患者的阿德福韦酯抗病毒应答率，其机制可能与改善此类患者肝细胞内的脂肪蓄积有关。

Objective To observe the effect of polyene phosphatidyl choline on antiviral merapy of chronic hepatitis B （CHB） patients combined with nonalcoholic fatty liver disease （NAFLD） by ade fovir dipivoxil, and investigate its related mechanism. Methods Forty-seven patients were randomly divided into two groups： control group （n = 23） and treatment group （n = 24）. The patients in control group were treated with adefovir dipivoxil only, while the patients in treatment group were treated with adefovir dipivoxil puls polyene phosphatidyl choline. The levels of HBV DNA, HBV marker were observed, and the improvement of fatty liver by ultrasound was observed. Results In the control group, the fatty liver improvement rate and the virus response rate was much higher than that in the control group. The virus response rate was 4.58 times in the treatment group that of the control group（P 〈0.05）. Conclusions Polyene phosphatidyl choline can obviously improve the viral response rate of chronic hepatitis B patients who concurrently suffered with NAFLD. The probable mechanism maybe its positive effect on the hepatocellular lipopexia.