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研究*

doi:10.3969/j.issn.1672-5069.2023.06.007

摘要/Abstract

摘要： 目的探讨应用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)患者的疗效。方法 2019年6月～2021年8月我院收治的CHB患者63例和CHB合并NAFLD患者43例,给予两组恩替卡韦治疗12个月。采用肝脏弹性检测仪检测肝脏受控衰减参数(CAP),采用荧光定量聚合酶链式反应法检测血清HBV DNA载量,使用全自动生化分析仪检测血清丙氨酸氨基转移酶(ALT),采用化学发光法检测血清HBeAg,采用ELISA法检测血清反应性氧化物(ROS)、脂联素(ADPN)和肿瘤坏死因子-α(TNF-α)水平。结果在治疗6个月和12个月,CHB组血清ALT复常率分别为69.8%和92.1%,均显著高于CHB合并NAFLD组(分别为41.9%和74.4%,均P<0.05),而两组血清HBV DNA阴转率无显著性差异(分别为88.9%和98.4%对81.4%和93.0%,P>0.05);在治疗12个月,CHB组血清ALT为(41.9±6.5)U/L,显著低于CHB合并NAFLD组【(71.5±8.4)U/L,P<0.05】,肝脏CAP为(211.8±50.1)dB/m,显著低于CHB合并NAFLD组【(288.0±13.4)dB/m,P<0.05】;CHB组血清ROS和TNF-α水平分别为(403.6±70.2)U/mL和(15.5±5.6)ng/L,均显著低于CHB合并NAFLD组【分别为(628.7±67.5)U/mL和(31.7±6.0)ng/L,P<0.05】,而血清ADPN水平为(17.7±1.2)ng/mL,显著高于CHB合并NAFLD组【(11.5±1.8)ng/mL,P<0.05】。结论应用恩替卡韦治疗CHB合并NAFLD患者可能因为存在的肝脂肪变性而影响生化学应答,抗病毒治疗可能无法改变体内氧化应激状态,这是一个值得认真研究的问题。

关键词: 慢性乙型肝炎, 非酒精性脂肪性肝病, 恩替卡韦, 受控衰减参数, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of entecavir in treatment of patients with chronic hepatitis B (CHB) and concomitant non-alcoholic fatty liver diseases (NAFLD). Methods 63 patients with CHB and 43 patients with CHB and NAFLD were recruited in this study between June 2019 and August 2021, and all patients received entecavir for anti-viral treatment for 12 months. The controlled attenuation parameter (CAP) of livers was detected byFibroscan-502. Serum HBV DNA loads were detected by fluorescence quantitative polymerase chain reaction. Serum alanine aminotransferase (ALT) levels were determined by automatic biochemical analyzer. Serum HBeAg and HBsAg were assayed by chemiluminescence method. Serum reactive oxide (ROS), adiponectin (ADPN) and tumor necrosis factor-α (TNF-α) levels were determined by ELISA. Results At the end of 6 month and 12 month anti-viral treatment, serum ALT normalization rates in patients with CHB were 69.8% and 92.1%, both significantly higher than 41.9% and 74.4% (P<0.05) in patients with CHB and NAFLD, while there were no significant differences respect to serum HBV DNA loss in the two groups (88.9% and 98.4% vs. 81.4% and 93.0%, respectively, P>0.05); at the end of 12 month treatment, serum ALT level in patients with CHB was (41.9±6.5)U/L, much lower than [(71.5±8.4)U/L, P<0.05] in patients with CHB and NAFLD, and the CAP of liver was (211.8±50.1)dB/m, much lower than [(288.0±13.4)dB/m, P<0.05] in patients with CHB and NAFLD; serum ROS and TNF-α levels in patients with CHB were (403.6±70.2)U/mL and (15.5±5.6)ng/L, both significantly lower than [(628.7±67.5)U/mL and (31.7±6.0)ng/L, respectively, P<0.05], while serum ADPN level was (17.7±1.2)ng/mL, much higher than [(11.5±1.8)ng/mL, P<0.05] in patients with CHB and NAFLD. Conclusion The existence of hepatic steatosis in patient with CHB and NAFLD might reduce the biochemical response to entecavir anti-viral therapy, which needs further investigation when the antiviral regimen is made in this setting.

Key words: Hepatitis B, Non-alcoholic fatty liver diseases, Entecavir, Controlled attenuation parameter, Therapy

周季颖, 谢月红, 于翠霞. 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研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 793-796.

Zhou Jiying, Xie Yuehong, Yu Cuixia. Decreased biochemical response to entecavir anti-viral therapy in patients with chronic hepatitis B and concomitant non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2023, 26(6): 793-796.

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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研究^*

Decreased biochemical response to entecavir anti-viral therapy in patients with chronic hepatitis B and concomitant non-alcoholic fatty liver diseases

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