Abstract: Objective The aim of this study was to investigate the impact of nonalcoholic fatty liver diseases (NAFLD) on antiviral response to entecavir in patients with chronic hepatitis B (CHB). Methods 125 patients with CHB and concomitant NAFLD and 120 patients with CHB at the same time were recruited in our hospital between January 2016 and June 2020, and all received entecavir therapy for 48 weeks. The controlled attenuation parameter (CAP) of the liver was determined by FibroScan 502, and serum HBV DNA and HBeAg were detected routinely. The COX proportional risk regression model was applied to multivariate correlation analysis. Results The blood platelet (PLT) counts, alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL) and CAP in patients with CHB and NAFLD were 189.0(156.0,212.0)×10⁹/L, 78.0(40.0, 138.0)U/L, 72.0(26.0, 98.0)U/L, 4.4(3.0, 5.8)mmol/L, 5.9(4.9,7.3)mmol/L, 3.8(2.7, 4.5)mmol/L and 290.0(245.0, 315.0)dB/m, all significantly different compared to [154.0(127.0, 184.0)×10⁹/L, 198.0(43.0, 160.0)U/L, 121.0(29.0, 105.0)U/L, 1.7(1.2, 3.2)mmol/L, 4.9(4.4, 5.4)mmol/L, 2.9(2.5, 3.6)mmol/L and 194.0(170.0, 232.0)dB/m, respectively, P<0.05] in patients with CHB; at the end of 24 week and 48 week treatment, almost all patients in the two groups had their serum HBV DNA transferred to negative and few patients in the two groups had their serum HBeAg transferred to negative (P>0.05), but serum ALT normalization rates in patients with CHB and NAFLD were 44.8% and 66.4%, both significantly lower than 95.8% and 100.0%(P<0.05) in patients with CHB; the multivariate COX analysis showed that the CAP was the independent risk factor for serum ALT normalization (HR:0.996, 95%CI:0.994-0.999, P<0.05), suggesting that the more high the CAP, the more lower the ALT normalization rates. Conclusion The concomitant NAFLD might frustrate the biochemical response to entecavir antiviral therapy in patients with CHB, which warrants simultaneously appropriate management of hepatic steatosis.

Key words: Hepatitis B, Nonalcoholic fatty liver diseaseS, Controlled attenuation parameter, Entecavir, Therapy