Abstract: Objective To investigate the difference in the efficacy of entecavir between treatment-na?ve hepatitis B envelope antigen (HBeAg)-positive chronic hepatitis B (CHB) patients with and without alanine aminotransferase (ALT) elevation in the early treatment.Methods Eighty-six CHB patients initially treated with entecavir in our hospital from January 2015 to October 2016 were selected. Among them, 28 patients with ALT elevation were in group A, and 58 patients without ALT elevation were in group B, The ALT normalization rate, hepatitis B virus deoxyribonucleic acid (HBV DNA) negative conversion rate, hepatitis B surface antigen (HBsAg) decline and HBeAg negative conversion rate were compared between the 2 groups at week 24,48 and 96 of antiviral therapy. Results At week 24 of treatment, in group A and B, the HBV DNA conversion rates were 75.0% and 51.7%, the HBsAg declines were 0.47 lg IU/mL (0.19-0.52 lg IU/mL) and 0.25 lg IU/mL (0.07-0.41 lg IU/mL), the differences were both statistically significant (P<0.05). At week 48, in group A and B, the HBV DNA conversion rates were 89.3% and 67.2%, the HBsAg declines were 0.62 lg IU/mL (0.27-0.74 lg IU/mL) and 0.32 lg IU/mL (0.11-0.47 lg IU/mL), the differences were both statistically significant (P<0.05). At week 96, in group A and B, the HBsAg declines were 0.69 lg IU/mL (0.30-0.99 lg IU/mL) and 0.36 lg IU/mL (0.20-0.60 lg IU/mL), the level of HBsAg were 3.30 ± 0.29 lg IU/mL and 3.48 ± 0.44 lg IU/mL, the differences were both statistically significant (P<0.05). While, there was no statistical difference in other indicators in other time periods between the 2 groups. Moreover, within the group, the indicators in both groups were significantly ameliorated.Conclusion ALT transient elevation in early entecavir treatment may accelerate HBV DNA clearance and HBsAg decline.

Key words: Entecavir, Chronic hepatitis B, Alanine aminotransferase, Hepatitis B virus deoxyribonucleic acid, Hepatitis B surface antigen, Hepatitis B envelope antigen, Immune activation