Abstract: Objective To retrospectively analyze the clinical data of E antigen positive chronic hepatitis B (CHB) patients admitted from January 2019 to January 2021, and to explore the influence of Controlled Attenuation Parameter (CAP) of fatty liver on the efficacy of antiviral therapy and liver fibrosis progression in CHB.Methods According to the results of CAP determined by transient elastography, the patients were divided into group A (CAP<260 db/m,N=60 cases), group B (CAP between 260 ~ 292 db/m,N=60 cases) and group C (CAP> 292 db/m,N=60 cases). The biochemical, virological and serological responses at 12 weeks, 24 weeks, 48 weeks and 96 weeks after antiviral treatment were retrospectively analyzed. Twenty patients in each group were randomly assigned for hepatological examination to evaluate liver fibrosis.Results There were no differences in age, sex, baseline alanine transaminase (ALT), aspartate transaminase (AST) and HBV-DNA among the three groups. The levels of body mass index (BMI), Triglyceride (TG), total cholesterol (TC) and γ-glutamyl transpeptadase (GGT) in Group C were higher than Group A (P<0.05) and the levels of cholesterol (TC) and triglyceride (TG) in group B were higher than those in group A (P<0.05). Twenty patients in each of the three groups were randomly divided into cirrhotic group and non-cirrhotic group according to the pathological results. Logistics regression analysis showed that there were significant differences in CAP value (P<0.01), BMI and TG between the cirrhotic and noncirrhotic groups (P<0.05). Receiver operator characteristic curve (ROC) analysis showed that the areas under the curve (AUC) of CAP and TG were the largest, which were 0.780 and 0.746. At 12th, 24th, and 48th weeks after entecavir (ETV) antiviral treatment, there were significant differences in the normalization rate of ALT levels, which were 35 cases (58.33%), 60 cases (100%), and 60 cases (100%) in Group A, 22 cases (36.67%), 55 cases (91.67%) and 59 cases (98.33%) in group B, 14 cases (23.33%), 21 cases (35%) and 48 cases (80%) in Group C, respectively, especially in Group A and Group C (P<0.01). The negative conversion rate of HBV DNA gradually increased with time after ETV treatment. At 24 weeks, the negative rates of HBV DNA in these three groups were 96.67% (58 cases), 75% (45 cases) and 63.33% (38 cases), respectively, with significant differences between group A and group B, or group A and group C (P<0.01). At the 48th and 96th week of antiviral treatment, the HBeAg seroconversion rate gradually increased, the HBeAg negative rate were 8.33% (5 cases) and 11.67% (7 cases) in Group A; 1.67% (1 case) and 5% (3 cases) in group B. and 0%, 1.67% (1 case) in Group C, respectively, with a significant difference between group A and group C.Conclusion Low CAP value, TG and BMI are independent indexes related to liver fibrosis progression in patients with CHB complicated with NAFLD. Liver steatosis affects biochemical response, delays early response of antiviral treatment, and affects serological response of HBeAg. Therefore, prevention and treatment of NAFLD in CHB patients complicated with NAFLD is of positive significance to improve antiviral efficacy.

Key words: Chronic hepatitis B, Nonalcoholic fatty liver, Virus load, Controlled Attenuation Parameter, Fibroscan