恩替卡韦治疗慢性乙型肝炎合并非酒精性脂肪性肝病患者疗效及其对肝组织脂肪变的影响

Impact of entecavir therapy on hepatic steatosis in patients with chronic hepatitis B and nonalcoholic fatty liver disease

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.