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目的探讨阿德福韦酯对HBe Ag阳性慢性乙型肝炎合并脂肪肝患者抗病毒疗效的作用。方法选择2011-2014年在承德医学院附属医院就诊的e抗原阳性慢性乙型肝炎(CHB)患者204例,按照有无合并脂肪肝分为两组,单纯乙肝组122例为对照组,乙肝合并非酒精性脂肪肝(NAFID)82例为观察组。两组患者均给予阿德福韦酯10mg/d口服治疗24、36、48周,观察两组丙氨酸氨基转移酶/天门冬氨酸基转移酶(ALT/AST)复常率(生物化学应答)、HBe Ag阴转率(血清学应答)及HBV-DNA阴转率(病毒学应答)。结果单纯CHB组ALT/AST复常率、HBVDNA阴转率及HBe Ag阴转率在治疗24和36周时显著高于乙肝合并脂肪肝组,两组相比差异有统计学意义(P<0.05);在治疗48周时单纯CHB组和合并脂肪肝组ALT/AST复常率差异有统计学意义(P<0.05),但HBV-DNA阴转率和HBe Ag阴转率差异无统计学意义(P>0.05)。结论脂肪肝对HBe Ag阳性慢性乙型肝炎患者应用阿德福韦酯抗病毒治疗有一定影响,延长阿德福韦酯治疗疗程可减少这种影响。
Objective To investigate the effect of adefovir dipivoxil on antiviral efficacy in patients with HBeAg-positive chronic hepatitis B and fatty liver. Methods 204 patients with e antigen positive chronic hepatitis B (CHB) from 2011 to 2014 in the Affiliated Hospital of Chengde Medical College were divided into two groups according to the presence or absence of fatty liver, 122 patients in the simple hepatitis B group as the control group, hepatitis B 82 cases of non-alcoholic fatty liver disease (NAFID) as observation group. Both groups were given adefovir dipivoxil 10mg / d orally for 24,36,48 weeks, observed the alanine aminotransferase / aspartate aminotransferase (ALT / AST) normalization rate (biochemistry Response), HBeAg negative rate (serological response) and HBV-DNA negative rate (virological response). Results The ALT / AST normalization rate, HBVDNA negative conversion rate and HBeAg negative conversion rate in CHB group were significantly higher than those in hepatitis B and fatty liver group at 24 and 36 weeks of treatment, with significant difference between the two groups (P <0.05 ). At 48 weeks of treatment, there was significant difference in ALT / AST normalization rate between CHB group and fatty liver group (P <0.05), but there was no significant difference between HBV-DNA negative rate and HBeAg negative conversion rate (P> 0.05). Conclusion Fatty liver has some effect on the use of adefovir dipivoxil in patients with HBeAg-positive chronic hepatitis B, prolonging adefovir dipivoxil treatment can reduce this effect.