Abstract: Objective To compare the efficacy of tenofovir fumarate and entecavir in patients with high viral load chronic hepatitis B (CHB).Methods A total of 104 CHB patients with high viral load were enrolled from Baoshan Branch of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2021 to October 2023. They were divided into observation group and control group by random number table method, with 52 cases each, and were treated with tenofovir pofol fumarate and entecavir respectively. Liver function, intestinal barrier function, efficacy, safety and inflammatory response were compared between the two groups.Results The HBV DNA negative conversion rate, alanine aminotransferase (ALT) normalization rate and HBeAg negative conversion rate were 94.23%, 94.23% and 11.54% in the observation group and 84.62%, 90.38% and 7.69% in the control group, respectively, and there were no difference between the two groups (P>0.05). After treatment, serum procalcitonin (PCT), aspartate aminotransferase (AST), tumor necrosis factor α (TNF-α), HBV DNA in the observation group, ALT, interleukin-4 (IL-4) were (0.03±0.01) μg/L, (36.16±4.42) U/L, (11.24±2.71) ng/L, (1.62±0.36) lgIU/mL, (37.43±4.94) U/L, (47.16±4.61), respectively. The corresponding values in control group was (0.03±0.01) μg/L, (37.51±4.78) U/L, (11.54±2.95) ng/L, (1.74±0.35) lgIU/mL, (38.81±5.39) U/L, (47.94±4.82) ng/L, respectively. There were no differences between the two groups (P>0.05). After treatment, there were no differences in serum endotoxin, diamine oxidase and D-lactic acid levels between the two groups (P>0.05). After treatment, the low-density lipoprotein cholesterol (LDL-C) (2.31±0.43) mmol/L and high-density lipoprotein cholesterol (HDL-C) (1.32±0.34) mmol/L in the observation group were lower than those in the control group [(2.70±0.52) mmol/L and (1.65±0.52) mmol/L, respectively] (P<0.05), there were no significant differences in serum creatinine and estimated glomerular filtration rate (eGFR) between the two groups (P>0.05).Conclusion Both entecavir and tenofovir fumarate can achieve satisfactory results in CHB patients with high viral load, both of which can reduce inflammation, improve liver function and intestinal barrier function, and have no significant effect on renal function. However, entecavir can affect blood lipid levels in patients.

Key words: Entecavir, Tenofovir pofol fumarate, High viral load, Chronic hepatitis B, Curative effect, Security