关键词: 慢性乙型肝炎, 非酒精性脂肪性肝病, 恩替卡韦, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of entecavir in treatment of patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver diseases (NAFLD). Methods A total of 118 patients with CHB were enrolled in our hospital between March 2018 and October 2020, and out of them, the concomitant NAFLD was found in 42 cases. All the patients with CHB were treated with oral entecavir for 12 months. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) levels were detected. Serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were also assayed. The controlled attenuation parameter (CAP) was measured by FibroScan 502. The peripheral blood lymphocyte subsets were detected by FCM. Results At the end of 12-month treatment, serum AST, ALT, GGT and the CAP in CHB patients with NAFLD were(72.3±8.9)U/L,(63.3±9.2)U/L,(76.2±9.8)U/L and (301.1±10.7)dB/m, all significantly higher than [(43.2±7.6)U/L, (45.1±8.3)U/L, (48.8±7.7)U/L and (262.7±7.6)dB/m, respectively, P＜0.05] in patients with CHB; serum TG, TC and LDL-C levels in patient with CHB and NAFLD were (3.5±0.7)mmol/L, (6.1±1.0)mmol/L and (2.7±0.3)mmol/L, all significantly higher than [(1.8±0.5)mmol/L, (4.7±0.9)mmol/L and (1.9±0.4)mmol/L, respectively, P<0.05], while serum HDL-C level was (1.2±0.4) mmol/L, significantly lower than [(1.6±0.3)mmol/L, P<0.05] in patients with CHB; the serum ALT normalization rate in patients with CHB and NAFLD was 66.7%, much lower than 82.9%(P＜0.05) in patients with CHB, while there were no significant differences as respect to serum HBeAg or HBsAg negative or HBV DNA loss rates between the two groups (P＞0.05); the percentage of peripheral blood CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells in patients with CHB and NAFLD were (32.6±4.9)% and (1.1±0.2), both significantly lower than [(36.4±5.2)% and (1.4±0.3), respectively, P＜0.05], while the percentage of CD8⁺ cells was (29.1±3.6)%, much higher than [(26.9±3.1)%, P＜0.05] in patients with CHB. Conclusion The antiviral efficacy of entecavir is good even in patients with CHB and concomitant NAFLD, but the hepatic steatosis might intervene with biochemical response in this scenario, which needs further clinical investigation.

Key words: Hepatitis B, Nonalcoholic fatty liver diseases, Entecavir, Therapy