慢性乙型肝炎合并非酒精性脂肪性肝病患者抗病毒治疗的疗效探讨

应若素; 陈燕宇; 卓丽; 范慧敏; 杨湛

doi:10.3969/j.issn.1001-5256.2013.08.013

慢性乙型肝炎合并非酒精性脂肪性肝病患者抗病毒治疗的疗效探讨

DOI: 10.3969/j.issn.1001-5256.2013.08.013

广州市第八人民医院肝病科

基金项目:

2012年“光辉”慢性乙型肝炎科研基金项目(GHF2012206)；

详细信息

中图分类号: R512.62
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出版历程
- 收稿日期: 2012-10-17
- 出版日期: 2013-08-20

Therapeutic effect of antiviral therapy in chronic hepatitis B patients with nonalcoholic fatty liver disease

Research funding:

摘要

摘要:
目的对慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者抗病毒治疗疗效进行回顾性分析,探讨肝细胞脂肪变是否影响CHB患者抗病毒的疗效。方法收集2004年1月至2011年12月在本院进行抗病毒治疗的110例CHB患者,CHB合并NAFLD患者99例,采用荧光定量PCR法检测血清HBV DNA水平,用化学发光法检测血清乙型肝炎两对半定量,采用全自动生物化学分析仪检测肝功能。计数资料采用χ2检验,计量资料采用t检验。结果 (1)干扰素抗病毒治疗时,24周单纯CHB患者较合并脂肪肝患者生化学应答率更高(χ2=4.069,P=0.044);48周HBV DNA阴转率明显优于后者(χ2=17.327,P=0.000)。对于HBeAg阳性患者,单纯CHB患者在24周的生化学应答率、24和48周时的HBV DNA阴转率、HBeAg阴转率均显著优于合并脂肪肝患者,两者比较差异具有统计学意义(P<0.05),48周时两组的生化学应答差异无统计学意义(p>0.05)。(2)核苷和核苷酸类药物抗病毒治疗时,48周单纯CHB患者的生化学应答率较高(χ2=7.620,P=0.006),24...
- 肝炎,乙型,慢性 /
- 脂肪肝 /
- 抗病毒药
Abstract:
Objective To retrospectively analyze the therapeutic effect of antiviral therapy in the chronic hepatitis B (CHB) patients with nonalcoholic fatty liver disease (NAFLD) and to investigate whether hepatocyte steatosis affects the response to antiviral therapy in CHB patients.Methods A total of 110 CHB patients and 99 CHB patients with NAFLD were enrolled in the study.Serum HBV DNA levels were measured by fluorescence quantitative PCR;serum HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb were quantified by chemiluminescence;biochemical indices were determined by automatic biochemical analyzer to evaluate the liver function.Results (1) When receiving antiviral therapy with interferon, the CHB patients had a significantly higher rate of alanine aminotransferase (ALT) /aspartate aminotransferase (AST) normalization after 24 weeks of treatment (χ2=4.069, P=0.044) and a significantly higher rate of HBV DNA clearance after 48 weeks of treatment (χ2=17.327, P=0.000) , as compared with the CHB patients with NAFLD;in all HBeAg-positive patients, those with only CHB had a significantly higher rate of ALT/AST normalization after 24 weeks of treatment (P<0.05) and significantly higher rates of HBV DNA clearance and HBeAg clearance after 24 and 48 weeks of treatment (P<0.05) 48="" as="" compared="" with="" those="" chb="" and="" but="" there="" was="" no="" significant="" difference="" in="" the="" rate="" of="" ast="" normalization="" between="" them="" after="" weeks="" treatment="" p="">0.05) . (2) When receiving antiviral therapy with nucleos (t) ide analogues, the CHB patients had a significantly higher rate of ALT/AST normalization than the CHB patients with NAFLD after 48 weeks of treatment (χ2=7.620, P=0.006) , but there was no significant difference in the rate of HBV DNA clearance between them after 24 and 48 weeks of treatment (P>0.05) ;in all HBeAg-positive patients, those with CHB and NAFLD had a significantly higher rate of HBeAg clearance after 24 weeks of treatment (P<0.05) and a significantly lower rate of ALT/AST normalization after 48 weeks of treatment (P<0.05) 24="" 48="" as="" compared="" with="" those="" only="" but="" there="" were="" no="" significant="" differences="" in="" the="" rate="" of="" ast="" normalization="" after="" weeks="" rates="" hbv="" dna="" clearance="" and="" hbeag="" treatment="" between="" them="" p="">0.05) .Conclusion To some extent, hepatocyte steatosis affects the response to antiviral therapy in CHB patients.
- hepatitis B /
- chronic /
- fatty liver

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参考文献(8)

[1]LIANG X, BI S, YANG W, et al.Epidemiological serosurvey of hepa-titis B in China-declining HBV prevalence due to hepatitis B vaccina-tion[J].Vaccine, 2009, 27 (47) :6550-6557.

[2] FAN JG, FARRELL GC.Epidemiology of non-alcoholic fatty liverdisease in China[J].J Hepatol, 2009, 50 (1) :204-210.

[3]Fatty Liver and Alcoholic Liver Disease Study Group of Chinese So-ciety of Hepatology.Guidelines for diagnosis and treatment of nonal-coholic fatty liver diseases[J].J Clin Hepatol, 2010, 26 (2) :120-124. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].临床肝胆病杂志, 2010, 26 (2) :120-124.

[4]ZHENG RD, CHEN ZR, CHEN JN, et al.The correlation betweenbody mass index'waist-to-hip ratio'waist circumference chronichepatitis B with nonalcoholic fatty liver diseases[J/CD].Chin JExp Clin Infect Dis (Electronic Edition) , 2012, 6 (4) :312-315. (in Chinese) 郑瑞丹, 陈卓然, 陈建能, 等.体质量指数、腰臀比及腰围与慢性乙型肝炎并非酒精性脂肪性肝病的相关性研究[J/CD].中华实验和临床感染病杂志 (电子版) , 2012, 6 (4) :312-315.

[5]ZHANG HF, ZHU SS.Current status and recent progress of antivi-ral treatment strategies for chronic hepatitis B in pediatric patients[J].J Clin Hepatol, 2012, 28 (12) :884-887. (in Chinese) 张鸿飞, 朱世殊.儿童慢性乙型肝炎抗病毒治疗现状[J].临床肝胆病杂志, 2012, 28 (12) :884-887.

[6]ATES F, YALNIZ M, ALAN S.Impact of liver steatosis on re-sponse to pegylated interferon therapy in patients with chronic hepa-titis B[J].World J Gastroenterol, 2011, 17 (40) :4517-4522.

[7] SHI JP, LU L, QIAN JC, et al.Impact of liver steatosis on antiviraleffects of pegylated interferon-alpha in patients with chronic hepa-titis B[J].Chin J Hepatol, 2012, 20 (4) :285-288. (in Chi-nese) 施军平, 陆璐, 钱建成, 等.肝脂肪变对慢性乙型肝炎患者聚乙二醇干扰素α治疗临床疗效的影响[J].中华肝脏病杂志, 2012, 20 (4) :285-288.

[8]JIN X, CHEN YP, YANG YD, et al.Association between hepatic steato-sis and entecavir treatment failure in chinese patients with chronic hepati-tis B[J].PLoS one, 2012, 7 (3) :e34198.

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