恩替卡韦治疗慢性乙型肝炎合并肝脂肪变的效果评价

Clinical effect of entecavir in treatment of chronic hepatitis B complicated by hepatic steatosis

目的探讨慢性乙型肝炎(CHB)合并肝脂肪变患者经恩替卡韦抗病毒治疗后的效果。方法纳入新疆巴州人民医院2014年6月-2015年6月就诊的HBe Ag阳性CHB患者164例,根据肝小叶内肝脂肪变的肝细胞数占总肝细胞数的比例将其分为3组:脂肪变肝细胞占比<5%(对照组,89例),脂肪变肝细胞占比5%~30%(A组,43例),脂肪变肝细胞占比>30%组(B组,32例)。患者均给予恩替卡韦治疗。检测患者治疗前和治疗后24、48周血清病毒学指标和肝功能指标变化。计量资料组间比较采用单因素方差分析,进一步两两比较采用Bonferroni法;计数资料组间比较采用χ~2检验。结果肝脂肪变不影响恩替卡韦治疗24周时的病毒学应答(P>0.05),但恩替卡韦治疗48周时,B组HBe Ag阴转率(34.4%vs 60.2%)和HBV DNA阴转率(40.6%vs67.4%)均明显低于对照组,差异具有统计学意义(P值分别为0.012和0.008);恩替卡韦治疗24和48周时,A组、B组的ALT复常率明显低于对照组,差异均有统计学意义(A组:P值分别为0.013、0.001;B组:P值分别为0.001、<0.001),而血清AST、ALP及GGT水平显著高于对照组,差异均有统计学意义(A组:P24值分别为<0.001、0.031、0.001,P48值分别为<0.001、0.021、<0.001;B组:P24值分别为<0.001、0.028、0.001;P48值分别为<0.001、0.017、<0.001)。结论肝脂肪变细胞占比>30%与恩替卡韦治疗48周时病毒学应答降低相关,肝脂肪变会影响CHB患者恩替卡韦治疗24周和48周时的生化学应答。

Objective To investigate the effect of antiviral therapy with entecavir in the treatment of chronic hepatitis B （CHB） complicated by hepatic steatosis. Methods A total of 164 HBeAg - positive CHB patients who visited Bazhou People＇s Hospital from June 2014 to June 2015 were enrolled, and according to the percentage of hepatocytes with steatosis in the hepatic lobules in all hepatocytes, they were divided into control group （ 〈 5% of hepatocytes with steatosis, 89 patients）, group A （5 % - 30% of hepatocytes with steatosis, 43 patients）, and group B （ 〉 30% of hepatocytes with steatosis, 32 patients）. All patients were treated with entecavir. The serum virological parameters and liver function parameters were measured before treatment and at weeks 24 and 48 of treatment. A one - way analysis of variance was used for comparison of continuous data between groups, and the Bonferroni method was used for comparison between any two groups ; the chi - square test was used for comparison of categorical data between groups. Results Hepatic steatosis did not affect the virologic response at week 24 of entecavir treatment （ P 〉 0.05 ）. However at week 48 of entecavir treatment, compared with the control group, group B had significantly lower HBeAg clearance rate （34.4% vs 60.2% , P = 0. 012） and HBV DNA clearance rate （40.6% vs 67.4% , P = 0. 008）. At weeks 24 and 48 of entecavir treatment, compared with the control group, groups A and B had a significantly lower alanine aminotransferase normaliza- tion rate than the control group （ group A ： P = 0. 013 and 0. 001 ; group B ： P = 0. 001 and P 〈 0. 001 ） and significantly higher levels of as- partate aminotransferase, alkaline phosphatase, and gamma - glutamyl transpeptidase （ group A ： P24 〈 0. 001, P24 = 0. 031, and P24 = 0. 001, P4s 〈0. 001, P4s =0. 021, and P48 〈0. 001 ; group B： P24 〈0. 001, P24 =0. 028, and P24 =0. 001, P48 〈0. 001, P48 =0. 017, P48 〈0. 001 ）. Conehmion A percentage of hepatocytes with steatosis of 〉 30% is associated with the reduction in virologic response at week 48 of entecavir treatment. Hepatic steatosis affects the biochemical response in CHB patients at weeks 24 and 48 of enteeavir treatment.