脂肪肝对HBeAg阳性慢性乙型肝炎患者疗效的影响

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摘要目的探讨脂肪肝对HBeAg阳性慢性乙型肝炎（CHB）患者应用阿德福韦酯抗病毒疗效的影响及其对于HBsAg预测抗病毒疗效价值的影响。方法选择2012年1月～2014年12月在该院门诊就诊的71例e抗原阳性CHB患者为研究对象，其中40例为单纯乙肝组，乙肝合并非酒精性脂肪肝（NAFID）31例为乙肝合并脂肪肝组。两组患者均给予阿德福韦酯10mg/d口服抗病毒治疗24周及36周，观察两组HBV-DNA阴转率（完全病毒学应答）有无差异。根据是否获得病毒学应答将单纯乙肝组及乙肝合并脂肪肝组分别分为完全病毒学应答组及无应答组，分别观察两组中的两亚组患者HBV-DNA、HBsAg在治疗过程中的变化趋势。结果乙肝合并脂肪肝组在治疗24、36周HBV-DNA阴转率分别为48.4%和61.3%,显著低于单纯乙肝组的75.0%、82.5%，差异有统计学意义（P<0.05）。在单纯乙肝组中，两亚组患者HBsAg含量在治疗后24周和治疗后36周时均随着HBV-DNA水平逐渐下降，完全病毒学应答组血清HBV-DNA及HBsAg水平明显低于无应答组，差异有统计学意义（P<0.01）。在乙肝合并脂肪肝组中，两亚组患者在治疗后24周和36周时HBV-DNA均明显下降，差异有统计学意义（P<0.01）；完全病毒学应答组HBsAg含量在治疗过程中虽有下降趋势，但无论在治疗后24周还是36周时与无应答组比较，差异无统计学意义（P>0.05）。结论合并脂肪肝影响乙型肝炎患者的HBV-DNA阴转率；乙肝合并脂肪肝时，HBsAg定量值变化不能反映治疗后病毒学应答情况。

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	王艳玲
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	时军利
	王磊

关键词 ：阿德福韦酯, 非酒精性脂肪肝, 慢性乙型肝炎

Abstract：ObjectiveTo investigate the impact of fatty liver on antiviral efficacy of Adefovir dipivoxil and the HBsAg′s predictive value in chronic hepatitis B(CHB)patientswith e antigen(HBeAg)positive.Methods71 CHB patientswith HBeAg positive in the hospital outpatient clinic from January 2012 to December 2014 were selected as study subjects,among which,40 cases were simple hepatitis B group,31 cases of hepatitis B with nonalcoholic fatty liver disease (NAFID)were hepatitis B with fatty liver group.Patients of two groups were given oral Adefovir dipivoxil 10 mg/d antiviral therapy for 24 weeks and 36 weeks,negative conversion rate(complete virological response)of HBV-DNA in two groups were observed.According to whether or not to obtain a viral response,simple hepatitis B group and hepatitis B with fatty liver group were divided into complete viral response group and non response group,the change trends of HBV-DNA and HBsAg of two subgroups in two groupswere respectively observed in the treatment process.ResultsAfter treatment for 24 weeks and 36 weeks,HBV-DNA negative conversion rate in the hepatitis B with fatty liver group was 48.4%and 61.3%respectively,significantly lower than 75.0%，82.5%in the simple hepatitis B group,and the difference was statistically significant(P<0.05).In the simple hepatitis B group,HBsAg level of two subgroups after treatment for 24 weeks and 36 weeks was gradually decreased with HBV-DNA level,serum HBV-DNA and HBsAg values after treatment for 24 weeks and 36 weeks in the complete viral response group was significantly lower that in non response group,and the difference was statistically significant(P<0.01).In the hepatitis B with fatty liver group,HBV-DNA level of two subgroups patients after treatment for 24 weeks and 36 weeks decreased significantly,and the difference was statistically significant(P<0.01);HBsAg level during treatment in the hepatitis B with fatty liver group was decreasing,but complete viral response group compared with the non response group after treatment for 24 weeks and 36 weeks,there was no statistically significant difference (P>0.05).Conclusion HBV-DNA negative conversion rate in patientswith hepatitis B can be influenced by complicated with fatty liver;hepatitis B complicated with fatty liver,the change of HBsAg value can not reflect the situation of viral response after treatment.

Key words： Adefovir dipivoxil Nonalcoholic fatty liver disease Chronic hepatitis B

基金资助:河北省省级临床重点专科建设项目；河北省承德市科学技术研究与发展计划项目（20142034）

通讯作者: 张冰（1980-），女，硕士，主任医师，主要从事消化系统疾病研究

作者简介: 王艳玲（1981-），女，硕士，主治医师，主要从事消化系统疾病研究

引用本文:

王艳玲;张冰;李炳庆;何培元;时军利;王磊. 脂肪肝对HBeAg阳性慢性乙型肝炎患者疗效的影响[J]. 中国当代医药, 2016, 23(33): 23-26.
WANG Yan-ling;ZHANG Bing;LIBing-qing;HE Pei-yuan;SHIJun-li;WANG Lei. Effect of fatty liver on the efficacy of HBeAg positive chronic hepatitis B patients. 中国当代医药, 2016, 23(33): 23-26.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2016/V23/I33/23

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