脂肪肝对阿德福韦酯治疗慢性乙型肝炎抗病毒疗效的影响分析

Impact of fatty liver on antiviral effect in chronic hepatitis B

目的探讨脂肪肝对慢性乙型肝炎(CHB)抗病毒疗效的影响。方法选择2011年1月至2014年4月在该院门诊就诊的乙型肝炎病毒e抗原(HBeAg)阳性CHB患者204例为研究对象,按照是否合并脂肪肝分为2组,其中单纯CHB患者122例为对照组,CHB合并非酒精性脂肪肝(NAFID)患者82例为观察组。两组患者均给予阿德福韦酯(10mg/d)口服抗病毒治疗24周,观察两组氨基转移酶复常率(生物化学应答)、HBeAg阴转率(血清学应答)及HBV-DNA阴转率(病毒学应答)的差异。并将两组中治疗后获得病毒学应答的患者再次进行比较,观察在获得病毒学应答患者中,单纯CHB组和CHB合并NAFLD组氨基转移酶复常率、HBeAg阴转率的差异。结果CHB合并NAFLD组氨基转移酶在治疗24周复常率为58.5%,显著低于单纯CHB组(72.1%),差异具有统计学意义;单纯CHB组HBV-DNA在治疗24周阴转率(67.2%vs.51.2%)及HBeAg阴转率(52.5%vs.37.8%)均显著高于合并NAFLD组,差异具有统计学意义;在获得病毒学应答患者中,单纯CHB组氨基转移酶复常率为96.3%,显著高于CHB合并NAFLD组(66.7%),差异具有统计学意义。而在获得病毒学应答患者中,HBeAg阴转率在单纯CHB组为78.0%,在CHB合并NAFLD组为73.8%,单纯CHB组略高于合并NAFLD组,但二者差异无统计学意义。结论脂肪肝对HBeAg阳性CHB患者应用阿德福韦酯抗病毒疗效有影响,而合并NAFLD是CHB抗病毒治疗时达病毒学应答和血清学应答而未达生物化学应答的重要原因。

Objective To investigate the impact of fatty liver on antiviral effect in the patients with chronic hepatitis B （CHB）. Methods A total of 204 patients with hepatitis B e antigen（HBeAg） positive CHB in the outpatient department of our hospital from January 2011 to April 2014 were selected as the research subjects and divided into the two groups according to whether complicating fatty liver： the simple CHB group（control group,122 cases） and：CHB complicating nonalcoholic fatty liver disease （NAFID） group（observation group,82 cases）. The two groups all received the 24-week antiviral therapy of adefovir （10 mg/d）. The differences in the normalization rate of ALT/AST （biochemical response）, HBeAg negative conversion rate （serological response） and HBV DNA negative conversion rate（virological response） were compared between the two groups. Then the cases obtaining the virological response after treatment in the two groups were compared again. Among the cases obtaining virological response, the differences in the normalization rate of ALT/AST（biochemical response） and HBeAg negative conversion rate（serological response） were compared between the simple CHB group and CHB complicating NAFID group. Results The normalization rate of ALT/AST after 24-week treatment in the CHB complicating NAFID group was 58. 5%, which was significantly lower than 72.1% in the simple CHB group,the difference was statistically significant; the negative conversion rate of HBV DNA and HBeAg after 24-week treatment in the simple CHB group was 67.2% and 52.5% ,which were significantly higher than 51.2 % and 37.8% respectively,the differences were statistically significant ; among the cases obtaining the virological response, the normalization rate of ALT/AST in the simple CHB group was 96.3% ,which was significantly higher than 66.7% in the CHB complicating NAFID group, the difference was statistically significant. But among the cases obtaining the virological response, the negative conversion rate of HBeAg was 78.0% in the simple CHB group and 73.8% in the CHB complicating NAFID group, the simple CHB group was slightly higher than the CHB complicating NAFID group without statistical difference. Conclusion NAFLD has impact on the antiviral effect of adefovir treatment in CHB patients with positive HBeAg, whereas complicating NAFLD is an important reason for reaching the virological response and serological response,but without reaching the biochemical response in the antiviral treatment of CHB complicating NAFID.