目的了解慢性乙型肝炎合并脂肪肝病人对替比夫定抗乙型肝炎病毒疗效的影响。方法回顾分析128例使用替比夫定抗乙型肝炎病毒治疗慢性乙型肝炎病人的肝组织病理检查,分为慢性乙型肝炎合并脂肪肝组43例,男性32例,女性11例,年龄(36±s 16)岁;单纯慢性乙肝组85例,男性62例,女性23例,年龄(37±11)岁。结果替比夫定抗病毒治疗1年丙氨酸转移酶(ALT)复常率2组分别为60%和84%(χ~2=5.892,P<0.01),乙肝病毒脱氧核糖核酸(HBV DNA)转阴率分别为70%和86%(χ~2=5.135,P<0.01)。肝穿病理结果存在肝细胞脂肪变性的慢性乙型肝炎病人对于替比夫定抗乙型肝炎病毒的ALT复常率和HBV DNA转阴率下降。结论肝细胞脂肪变性是影响替比夫定抗病毒疗效的重要因素之一。 Objective To investigate the effect of telbivudine on hepatitis B virus (HBV) in patients with chronic hepatitis B and fatty liver. Methods Retrospective analysis of 128 cases of patients with chronic hepatitis B using telbivudine anti-hepatitis B virus in liver biopsy, divided into chronic hepatitis B with fatty liver in 43 cases, 32 males and 11 females, age ( 36 ± s 16) years old; simple chronic hepatitis B group 85 cases, 62 males and 23 females, aged (37 ± 11) years. Results The rates of alanine aminotransferase (ALT) at 1 year after telbivudine treatment were 60% and 84%, respectively (χ ~ 2 = 5.892, P <0.01). HBV DNA ) To negative rate were 70% and 86% (χ ~ 2 = 5.135, P <0.01). Results of liver biopsy Liver cells with steatosis in patients with chronic hepatitis B for telbivudine anti-hepatitis B virus ALT normalization rate and HBV DNA loss rate decreased. Conclusion Steatosis of hepatocytes is one of the important factors affecting the efficacy of telbivudine antiviral therapy.