Abstract: Objective To evaluate the therapeutic efficacy of entecavir combined with polyene phosphatidylcholine (PPC) in patients with chronic hepatitis B (CHB) complicated by nonalcoholic steatohepatitis (NASH). Methods A total of 102 patients with CHB complicated by NASH who were treated in the 904th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Anny from January 2022 to January 2025 were enrolled. According to the treatment regimen, patients were divided into two groups: the monotherapy group (entecavir alone, n=52) and the combination group (entecavir plus PPC, n=50). Virological indicators, liver function, metabolic and inflammatory parameters, as well as histological improvements were compared between the two groups. Results After 48 weeks of treatment, the HBV DNA level in the combination group (2.1±0.7) lg U/mL was significantly lower than that in the monotherapy group [(2.7±0.8) lg U/mL, P<0.05). The ALT level in the combination group (28.4±13.2) U/L was also significantly lower than that in the monotherapy group [(36.2±17.5) U/L, P<0.05]. The rate of ALT normalization was 88.0% (44/50) in the combination group, higher than 65.4% (34/52) in the monotherapy group (P<0.05). Regarding hepatic fibrosis and steatosis indices, the combination group showed APRI, FIB-4, LSM, CAP, and MRI-PDFF values of (0.7±0.3) kPa, (1.8±0.7) kPa, (6.8±2.1) kPa, (243.2±28.4) dB/m and (11.8±3.7) %, respectively, which were all significantly lower than those in the monotherapy group [(1.0±0.4) kPa, (2.2±0.8) kPa, (7.8±2.3) kPa, (273.0±30.8) dB/m and (14.6±4.2) %, P<0.05]. For metabolic and inflammatory parameters, HOMA-IR, TG, hs-CRP, and IL-6 levels in the combination group were (2.3±0.9) mmol/L, (1.7±0.5) mmol/L, (2.5±1.1) mg/L and (5.9±2.1) pg/mL, respectively, lower than those in the monotherapy group [(2.8±1.0) mmol/L, (1.9±0.5) mmol/L, (3.3±1.2) mmol/L and (6.9±2.3) pg/mL, P<0.05]. Histological results showed that the NAS total score, Ishak fibrosis score, and CPA in the combination group were (3.1±1.0) points, (2.4±0.8) points and (4.9±1.8)%, respectively, which were significantly lower than those in the monotherapy group [(4.2±1.1) points, (3.1±0.9) points and (6.8±2.1)%, P<0.05]. Conclusion Entecavir combined with polyene phosphatidylcholine can significantly improve virological, hepatic, metabolic, and inflammatory indicators in patients with CHB complicated by NASH, alleviates hepatic steatosis and fibrosis, and promotes structural repair of liver tissue.

Key words: Chronic hepatitis B, Nonalcoholic steatohepatitis, Entecavir, Polyene phosphatidylcholine