摘要
目的探讨恩替卡韦治疗慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者疗效及其对脂肪肝的影响。方法 25例CHB患者接受恩替卡韦治疗96 w。经肝穿组织学检查行脂肪变分级,使用磁共振氢质子波谱成像(~1H-MRS)检测脂水比(LWR)以判断肝脂肪变变化。采用自行设计的健康问卷调查表调查生活习惯并予以量化。结果 25例CHB患者经组织病理学检查,发现脂肪变≥F1者16例(64.0%),被认为合并脂肪肝;治疗96 w末,21例(84.0%)患者达到完全病毒学应答;治疗前后血清HBsAg和HBV DNA水平差异有统计学意义(P<0.05),而血清TBIL、ALT、体质指数、腰臀比、低密度脂蛋白胆固醇等无统计学意义的变化(P>0.05);根据治疗前后LWR变化,发现治疗后脂肪变变重者8例,未变者13例,改善者4例,而脂肪肝改善患者治疗后腰臀比显著下降(P<0.05);对生活习惯得分分析发现,每日主食量对脂肪肝的影响比较大(P<0.05),即每日主食量大者会加重脂肪肝。结论恩替卡韦治疗未能改善CHB合并NAFLD患者肝脏脂肪变程度,而这些患者在抗病毒的同时控制主食,降低腰臀比或许能减轻肝脂肪变程度。
Objective To investigate the impact of entecavir therapy on hepatic steatosis in patients with chronic hepatitis B(CHB)and nonalcoholic fatty liver disease(NAFLD).Methods A total of 25 patients with histological-proved chronic hepatitis B(CHB)were enrolled in this prospective study.The patients were treated with entecavir for 96 weeks.The hydrogen proton spectroscopy(1H-MRS)was performed and the life style was investigated by a questionnaire in all patients.Results 16 patients(64.0%)with CHB were found having liver steatosis≥F1 by liver biopsies.21 patients(84.0%)obtained complete viralogic response at the end of 96 weeks;serum HBsAg and HBV DNA levels at baseline and at the end of observation were significantly different(P<0.05),while there were no significant differences as respect to serum bilirubin,ALT,body mass index,waist-hip ratio and low-density lipoprotein cholesterol(P>0.05);at the end of 96 weeks,8 were found having liver steatosis deteriorated,13 unchanged and 4 improved by the lipid-water ratio(LWR)of 1H-MRS out of 16 patients with NAFLD and the waist-hip ratio decreased in those with improved steatosis(P<0.05);the analysis of life habit showed that the staple food was the independent factor which influenced the outcome of hepatic steatosis(P<0.05).Conclusion Entecavir treatment could not improve hepatic steatosis in patients with CHB and NAFLD,and the decreased waist-to-hip ratio might be associated the improvement of liver steatosis in those patients.
作者
黄娇凤
林苏
王明芳
黄映芳
熊美连
朱月永
Huang Jiaofeng;Lin Su;Wang Mingfang(Centre of Liver Disease Study,First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China)
出处
《实用肝脏病杂志》
CAS
2018年第6期863-867,共5页
Journal of Practical Hepatology
基金
福建省教育厅中青年教师教育科研基金资助项目(编号:JA15207/JB12111)
关键词
慢性乙型肝炎
非酒精性脂肪肝
恩替卡韦
磁共振波谱
疗效
Hepatitis B
Nonalcoholic fatty liver disease
Entecavir
Magnetic resonance spectroscopy
Therapy