Abstract: Objective To analyze the influence of nonalcoholic fatty liver disease (NAFLD) on antiviral treatment response of children and adolescents with chronic hepatitis B (CHB). Methods From March 2013 to April 2019, there were 316 children and adolescents with CHB were enro[jg1]lled in this study. Within them, 76 patients including 63 males and 13 females had NAFLD, with an average age of 6.6 (3.0, 15.5) years. Another 238 patients including 182 male and 56 female only had CHB, with an average age of 6.0 (3.0, 13.5) years old. The CHB patients were divided into CHB with NAFLD group and CHB alone group according to whether they were complicated with NAFLD or not. Measurement data were expressed as mean±standard deviation (±s) and analyzed with T test. Counting data were expressed as percentage (%) and analyzed with Chi square test. Results The BMI of CHB with NAFLD group [21.6 (19.7, 24.4) kg/m²] was significantly higher than that of CHB alone group [19.6(17.5, 22.0) kg/m²] (P<0.05). The ratio of liver and spleen CT values in CHB with NAFLD group were 1.1(0.9, 1.2), which were significantly higher than those of 0.6(0.5, 0.8) in CHB alone group (t=-11.635, P<0.05). The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC) and total glycerol (TG), pre-albumin, and fibrinogen in CHB alone group were 87 (51, 142) U/L, 68 (45, 110) U/L, 3.6 (3.2, 4.1) mmol/L and 0.9(0.7, 1.1)mmol/L, 26.7(24.1,29.2)g/L、152(138,185)mg/L及2.7(2.4,3.3)g/L, respectively, which were significantly lower than those of 98(58, 172) U/L, 82 (48, 140) U/L, 4.8(3.4, 5.8)mmol/L,1.4(0.9, 1.9)mmol/L,23.8(22.0,26.4)g/L,140(120,167)mg/L,and 2.4(1.9,2.8)g/L in CHB with NAFLD group [t=4.370, 6.517, 8.610, 12.005, P<0.05)]. After 24 weeks antiviral treatment, the HBV-DNA seroconversion rates in the CHB with NAFLD group and CHB alone group were 217 cases (91.1%) and 53 cases (69.7%), respectively, with significant difference (P<0.05).There was no significant difference between the HBV-DNA seroconversion rates of these two groups after 12 weeks antiviral treatment. In addition, the ALT and AST normalization rates of CHB alone group at 12 and 24 weeks were 138 cases (58.0%) and 154 cases(64.7%), and 166 cases (69.7%) and 180 cases (75.6%), respectively, which were significantly higher than those of 30 cases (38.55) and 32 cases(41.0%), and 41 cases (53.9%) and 44 cases (57.9%) of the CHB with NAFLD group, respectively, with statistical significant difference (P<0.05). The HBV DNA responsive rate of antiviral treatment for 24 weeks in CHB alone group (238 cases, 100%)were significantly higher than that of CHB with NAFLD group(61 cases,80.2%)(P<0.05). When comparing the anti-viral treatment responsive and non-responsive CHB patients with NAFLD, the ratio of liver and spleen CT values, TC, ALT, AST and HBV DNA of the responsive patients were 0.7(0.5, 0.8), 3.0(2.3, 3.7)mmol/L, 42(28, 74)U/L and 44(28, 78) U/L, respectively,which were significantly different with those of [0.5(0.4, 0.6), 3.8(3.2, 5.0)mmol/L, 64(37, 92)U/L, 70(28, 98)U/L and 7.3(6.3, 8.5)log10 copies/ml in the non-response patients (t=-4.440, 6.746, 13.082, 15.146, 9.320, P<0.05)]. Conclusion The presence of NAFLD in children and adolescent CHB patients may affect their biochemical responsiveness and viral clearance to anti-viral treatment.

Key words: Nonalcoholic fatty liver disease, Chronic hepatitis B, Antiviral therapy;children and adolescents