替诺福韦酯治疗合并非酒精性脂肪肝的慢性乙型肝炎患者的疗效

Therapeutic efficacy of tenofovir on chronic hepatitis B combined with nonalcoholic fatty liver

目的分析替诺福韦酯(TDF)治疗合并非酒精性脂肪肝(NAFLD)的慢性乙型肝炎(CHB)患者的疗效,为此类患者抗病毒治疗提供临床思路和参考。方法纳入182例乙肝病毒e抗原(HBe Ag)阳性CHB患者,其中单纯CHB患者100例为对照组,合并NAFLD患者82例为观察组,两组均予48周TDF 300 mg/d抗病毒治疗,并进行临床随访。结果 (1)观察组患者丙氨酸氨基转移酶(ALT)复常率、HBV-DNA清除率及HBe Ag血清阴转率在TDF治疗12和24周时均显著低于对照组,差异有统计学意义(P<0.05);在36和48周时两组间HBV-DNA清除率和HBe Ag血清阴转率差异无统计学意义(P>0.05),但ALT复常率差异有统计学意义(P<0.05)。(2)Kaplan-Meier分析发现,对照组患者ALT复常(Log Rank=8.626,P=0.003)、HBV-DNA清除(Log Rank=4.342,P=0.037)及HBe Ag血清阴转(LogRank=3.962,P=0.047)均显著早于观察组。结论 NAFLD既可影响HBe Ag阳性CHB患者应用TDF抗病毒治疗的生化学、病毒学及血清学应答,又是CHB患者抗病毒治疗基础上获得病毒学和血清学应答,但生化学应答不佳的重要原因,延长TDF治疗疗程有助于提高此类患者抗病毒疗效,并应在抗病毒治疗同时对NAFLD同步治疗。

Objective To investigate the therapeutic efficacy of tenofovir（TDF）on hepatitis B e antigen（HBeAg）-positive chronic hepatitis B（CHB）combined with nonalcoholic fatty liver（NAFLD）. Methods A totalof 182 patients with CHB were enrolled in this study,including 100 CHB patients assigned as control group andanother 82 patients with CHB and NAFLD as observational group. Both groups received TDF 300 mg/d therapy for48 weeks and completed the follow-up. Results（1）At weeks 12 and 24,the rates of alanine aminotransferase（ALT）normalization,HBV-DNA clearance and HBeAg seroconversion were significantly lower in the observationalgroup,compared with the control group（P〈0.05）. However,at weeks 36 and 48,there was no significant differ-ence in the rates of HBV-DNA clearance and HBeAg seroconversion between the groups（P〈0.05）,while the rateof ALT normalization was still lower in the observational group（P〈0.05）.（2）Kaplan-Meier analyses revealedthat the responses of ALT normalization（Log Rank = 8.626,P = 0.003）,HBV-DNA clearance（Log Rank =4.342,P = 0.037）,and HBeAg seroconversion（Log Rank = 3.962,P = 0.047）in the control group were earlierthan the observation group. Conclusions NAFLD might have impact on the virological,biochemical and serologi-cal responses of TDF antiviral treatment in patients with CHB,contributing to the earlier achievement but poorerbiological response of virological and serological responses in CHB patients. The extension of TDF treatment andsynchronous treatment of NAFLD could be helpful for the patients with CHB and NAFLD.