关键词: 富马酸丙酚替诺福韦, 慢性乙型肝炎, 非酒精性脂肪性肝病, 疗效, 肾功能

Abstract: Objective To explore the efficacy and safety of tenofovir alafenamide fumarate (TAF) in the treatment of chronic hepatitis B (CHB) patients complicated with fatty liver disease.Methods A total of 86 patients with CHB and fatty liver disease diagnosed and treated in our hospital from June 2019 to September 2020 were enrolled. They were divided into a the treatment-naive group (22 cases) and a treatment-experienced group (64 cases). The clinical markers of 2 groups were compared at baseline and 48 weeks after treatment.Results After 48 weeks of treatment in treatment-naive group, the undetected rate and the ratio of hepatitis B virus (HBV) DNA less than 20 IU/mL (50.0% vs 0.0%, 22.7% vs 0.0%, respectively, P<0.001) were higher than those at baseline. The levels of beta2-microglobulin (β2-MG) (median 1.82 mg/L vs 2.02 mg/L, P<0.001) and fasting blood glucose (median 5.11 mmol/L vs 5.41 mmol/L, P<0.001) at 48 weeks after treatment were lower than those at baseline, and the difference was statistically significant. In the treatment-experienced group, the undetected rate of HBV DNA at 48 weeks after treatment was higher than that at baseline, and the rate of HBV DNA more than 20 IU/mL at 48 weeks after treatment was lower than that at the baseline (64.1% vs 39.1%, 12.5% vs 35.9%, respectively, P=0.003); Total cholesterol (TC) (median 4.71 mmol/L vs 4.00 mmol/L, P<0.001), triglyceride (TG) (median 2.19 mmol/L vs 2.00 mmol/L, P<0.001), high-density lipoproteincholesterol (HDL-C) (median 1.16 mmol/L vs 1.00 mmol/ L, P<0.001) at 48 weeks after treatment were higher than those at baseline, low-density lipoprotein cholesterol (LDL-C) (median 2.61 mmol/L vs 3.00 mmol/L, P<0.001) and fasting blood glucose at 48 weeks after treatment (median 5.60 mmol/L vs 6.00 mmol/L, P<0.001) were lower than those at baseline, the differences were statistically significant.Conclusion CHB patients complicated with fatty liver disease in treatment-naive and treatment-experienced group can achieve higher virological and biochemical responses after treated with TAF, and the renal impairment of TAF is lower. However, TAF may have potential effect on increasing TCH, TG and HDL-C levels, lowering fasting blood sugar.

Key words: Tenofovir alafenamide fumarate, Chronic hepatitis B, Non-alcoholic fatty liver disease, Efficacy, Renal function