摘要
目的探讨合并非酒精性脂肪性肝病（NAFLD）对HBeAg阳性CHB患者核苷（酸）类似物抗病毒疗效的影响。方法回顾性分析2007年1月至2009年12月在温州医学院附属第一医院门诊和住院治疗的资料完整的HBeAg阳性CHB初治患者332例。最后完成研究316例。其中经超声证实合并NAFLD者106例（合并NAFLD组），单纯CHB者210例（单纯CHB组），均使用拉米夫定＋阿德福韦酯，或恩替卡韦单药抗病毒治疗96周。比较两组患者治疗前及治疗后不同时间点的ALT、病毒学应答和HBV血清学标志变化。计数资料比较采用X2检验，相关分析采用Logistic多元回归分析。结果合并NAFLD组HBVDNA转阴率在第12、24、48周时分别为46．2％、61．3％、74．5％，明显低于单纯CHB组的61．9％、73．8％、83．8％，差异均有统计学意义（X2=7．05l、5．195、3．895，均P〈0．05）；但在第96周时两组HBVDNA转阴率分别为85．8％和91．9％，差异无统计学意义（X2=2．838，P〉0．05）。合并NAFLD组患者HBeAg转阴率在48、96周时分别为27．4％、37．7％，与单纯CHB组33．3％、44．8％相比，差异无统计学意义（X2=1．169、1．424，均P〉0．05）；而96周时，合并NAFLD组患者HBeAg转换率显著低于单纯CHB组（17．9％比29．5％，X2=4．972，P〈0．05）。48、96周时，合并NAFLD组患者ALT复常率也显著低于单纯CHB组（69．8％比80．5％，82．1％比91．0％，均P〈0．05）。多元Logistic回归分析显示，三酰甘油（OR=3．725，P=0．000）、尿酸（OR=1．005．P=0．040）、空腹血糖（OR=3．067，P=0．000）为脂肪肝的独立危险因素，且各时间点NAFLD均为病毒学应答的危险因素（12周：0R=2．749，P=0．001；24周：OR=1．981，P=0．030；48周：0R=2．348，P=0．021；96周：OR=8．053，P=0．001）。结论在抗病毒治疗期间，合并NAFLD可影响CHB患者生物化学应答和血清学应答，并影响其早期病毒学应答。
Objective To investigate the effect of non-alcoholic fatty liver disease （NAFLD） on virologic response in chronic hepatitis B patients treated with nueleos（t）ide analogues. Methods Three hundred and thirty-two treatment-naive patients with hepatitis B e antigen （HBeAg）-positive chronic hepatitis B （CHB） who visited clinic or hospitalized in the First Affiliated Hospital of Wenzhou Medical College from January 2007 to December 2009 were enrolled and finally 316 patients completed the research. Among them, 106 patients were diagnosed with CHB complicated with NAFLD by ultrasonography （NAFLD group）, and the remaining 210 patients were diagnosed with simple CHB （CHB group）. Patients in both groups were treated with combination therapy of lamivudine （LAM） plus adefovir dipivoxil （ADV） or entecavir （ETV） monotherapy for 96 weeks. Alanine aminotransferase （ALT） levels, virologic response and serological response were compared pre-and post-treatment in both groups.Enumeration data was compared using X2 test, and correlation analysis was performed using Logistic multivariate regression analysis. Results Rates of hepatitis B virus （HBV） DNA clearance in the NAFLD group at week 12, 24 and 48 were 46.2%, 61.3% and 74.5%, respectively, which were all significantly lower than those in CHB group （61.9%, 73.80% and 83.8%, %2 =7. 051, 5. 195, 3. 895, respectively; all P〈0.05）. However, rates of HBV DNA clearance were 85.80% in the NAFLD group and 91.9% in the CHB group at week 96. This difference did not reach the level of significance （2 = 2. 838, P〉0.05）. Rates of HBeAg loss in the NAFLD group were 27.4% at week 48 and 37.7% at week 96, compared to 33.3% and 44.8% in the CHB group. There was no significant difference in these two groups （X2 = 1. 169, 1. 424, both P〉O, 05）. Rate of HBeAg seroconversion in the NAFLD group was significantly lower than that in the CHB group at week 96 （17.9% vs29.5%, X2=4.972, P〈0.05）. Rates of ALT normalization were also found to be significantly lower in the NAFLD group than those in the CHB group at week 48 （69.8% vs80.5%, P〈0.05） and at week 96 （82.1% vs 91.0%, P〈0.05）. Multivariate regression analysis demonstrated that serum levels of triacylglycerol （OR= 3. 725, P= O. 000）, uric acid （OR= 1. 005, P = 0. 040） and fasting blood-glucose （OR = 3. 067, P = 0. 000） were independent risk factors associated with NAFLD. NAFLD was found to be a risk factor of virologic response at each time point throughout the treatment. （week 12, 0R=2.749, P=0.001; week 24, 0R=1.981, P=0.030; week 48, 0R=2.348, P=0.021; week 96, 0R=8.053, P=0.001）. Conclusions During antiviral therapy, NAFLD may affect biochemical and serological responses in CHB patients treated with nucleos（t） ide analogues, and may affect early virologic response in these patients.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2014年第3期158-161,共4页
Chinese Journal of Infectious Diseases
关键词
肝炎
乙型
慢性
脂肪肝
抗病毒药
核苷类
Hepatitis B, chronic
Fatty liver
Antiviral agents
Nucleosides
