目的观察恩替卡韦治疗慢性乙型肝炎合并脂肪肝疗效。方法回顾分析272例使用恩替卡韦抗乙型肝炎病毒治疗的慢性乙型肝炎患者,经超声诊断分为慢性乙型肝炎合并脂肪肝组58例;单纯慢性乙肝组214例。均给予恩替卡韦0.5mg空腹口服1次/d,抗病毒治疗,疗程48周,比较二组患者治疗结束时病毒学应答和生化学应答的差异。结果慢性乙型肝炎合并脂肪肝58例患者有40例(68.97%)出现病毒学应答,单纯慢性乙型肝炎214例患者有177例出现病毒学应答(82.71%)。二组病毒学应答率分别为68.97%(40/58)和82.71%(177/214)(χ2=5.344,P<0.05),差异有统计学意义。ALT复常率分别为60.34%(35/58)和73.83%(158/214)(χ2=4.028,P<0.05),存在肝细胞脂肪变性的慢性乙型肝炎患者对于恩替卡韦抗乙型肝炎病毒的ALT复常率和HBV-DNA转阴率下降。结论肝细胞脂肪变性是影响恩替卡韦抗病毒疗效的重要因素之一。 Objective To observe the curative effect of entecavir on chronic hepatitis B with fatty liver. Methods Retrospective analysis of 272 cases of chronic hepatitis B patients treated with entecavir anti-hepatitis B virus were divided into 58 cases of chronic hepatitis B with fatty liver by ultrasound diagnosis; 214 cases of chronic chronic hepatitis B group. Were given 0.5mg entecavir fasting oral once a day, antiviral therapy, the course of 48 weeks, comparing the two groups of patients at the end of the treatment of virological and biochemical differences in response. Results Virological responses were found in 58 (68.97%) of 58 patients with chronic hepatitis B and fatty liver and in 177 of 217 patients with chronic hepatitis B (82.71%). The virological response rates of the two groups were 68.97% (40/58) and 82.71% (177/214), respectively (χ2 = 5.344, P <0.05), the difference was statistically significant. ALT normalization rates were 60.34% (35/58) and 73.83% (158/214) respectively (χ2 = 4.028, P <0.05). Patients with chronic hepatitis B who had steatosis of hepatocytes had a significantly lower response to entecavir anti-hepatitis B virus ALT normalization rate and HBV-DNA negative rate decreased. Conclusion Steatosis of hepatocytes is one of the important factors that affect the anti-virus efficacy of entecavir.