Clinical Observation Of Entecavir In The Treatment Of E Antigen-positive Chronic Hepatitis B Combined With Non-alcoholic Fatty Liver Disease

[Background] Hepatitis B virus(HBV)infection remains a serious global public health problem,particularly in less economically developed countries;although the widespread use of the hepatitis B vaccine has significantly reduced the number of new cases,however,due to the large population base,at least 296 million people worldwide are currently infected with HBV.According to Polaris International Epidemiology Collaboration projections,in 2016 the general The prevalence of HBs Ag in the population was 6.1%,with 86 million cases of chronic HBV infection.Non-alcoholic fatty liver disease(NAFLD)is a metabolic stress liver injury closely related to insulin resistance and genetic susceptibility,with a disease spectrum that includes nonalcoholic hepatic steatosis,non-alcoholic steatohepatitis,cirrhosis and hepatocellular carcinoma.In recent years,with changes in diet and lifestyle,the prevalence of NAFLD in the general adult population ranges from 6.3% to 45%,and NAFLD has become the number one chronic liver disease in China,accompanied by an increasing number of NAFLD and a rising trend of patients with CHB combined with NAFLD.Currently,there is no "guideline" or "expert consensus" for the antiviral treatment of patients with CHB combined with NAFLD.Entecavir,as a potent,low resistance,low side effect and inexpensive first-line antiviral drug,is widely used in clinical practice.This study aims to analyze the antiviral efficacy of entecavir in patients with CHB combined with NAFLD and provide new clinical insights.[Objective] To evaluate the efficacy of entecavir in the treatment of patients with CHB combined with NAFLD.[Methods] A total of 208 patients with chronic hepatitis B who met the inclusion criteria were collected from January 2021 to January 2022 at Huizhou Hospital,Guangzhou Medical University.The patients were divided into 55 cases in the CHB alone group and 153 cases in the CHB combined with NAFLD group,and then the CHB combined with NAFLD group was divided into 51 cases in the CHB combined with mild fatty liver group,49 cases in the CHB combined with moderate fatty liver group and 53 cases in the CHB combined with severe fatty liver group according to the liver fat attenuation values of 238-259 d B/m,259-292 d B/m and >292 d B/m.All patients in each group took entecavir 0.5mg/qd combined with compound glycyrrhizin2 tablets/tid on an empty stomach for 48 weeks,and the changes in liver function,blood lipids and HBV-DNA before and after treatment were observed and compared.[Results] 1.Improvement of liver function at different time points before and after:patients in the four groups showed a significant decrease in ALT,AST,GGT and TBIL indexes after 48 weeks of treatment compared with those before,AST,GGT and TBIL indexes decreased significantly after 48 weeks of treatment compared with those before treatment(P < 0.05);comparison between groups: ALT,AST,GGT and TBIL indexes in the CHB combined with severe fatty liver group were significantly higher than those in the CHB alone group after 48 weeks of treatment(P< 0.05);ALT normalization rate in the CHB combined with severe fatty liver group after 48 weeks of treatment(82.1%,43/53)The mean and median time to ALT normalization was significantly longer in the CHB combined with severe fatty liver group(40 weeks,24 weeks)than in the CHB combined with mild fatty liver group(10weeks,4 weeks)and the CHB combined with moderate fatty liver group(98%,48/49)(P<0.05),The mean and median ALT normalization time(40 weeks,24 weeks)was significantly longer in the CHB combined with mild steatohepatitis group(10 weeks,4weeks),CHB combined with mild steatohepatitis group(20 weeks,8 weeks),and CHB combined with moderate steatohepatitis group(11 weeks,8 weeks)(P < 0.05);2.Virological suppression: After 48 weeks of treatment,the HBV-DNA conversion rates in the four groups were 86.9% in the hepatitis B alone group(86.9%),96.6% in the CHB combined with mild steatohepatitis group(96.6%),87.8% in the CHB combined with moderate steatohepatitis group(87.8%),and CHB combined with severe fatty liver group(96.4%),with no statistical difference between the groups.The mean and median time to HBV-DNA regression was longer in the CHB alone group(27.47weeks/24 weeks)than in the CHB combined with mild fatty liver group(15 weeks/12weeks),CHB combined with moderate fatty liver group(17 weeks/12 weeks)and CHB combined with severe fatty liver group(23 weeks/12 weeks)(p<0.05).[Conclusion] 1.Hepatic steatosis facilitates HBV-DNA inhibition.2.Hepatic steatosis may affects the biochemical response of patients with CHB treated with ETV in combination with compound glycopyrrolate tablets.