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目的 探讨富马酸替诺福韦二吡呋酯（tenofovir disoproxil fumarate, TDF）与富马酸丙酚替诺福韦（tenofovir alafenamide fumarate, TAF）对合并血脂异常的慢性乙型肝炎（chronic hepatitis B, CHB）患者脂代谢的影响。方法 选取2022年3月至2023年3月就诊于运城市中心医院的116例需抗病毒治疗且基线合并血脂异常的CHB患者作为研究对象。采用随机数字表法将患者分为TDF组（n=58）与TAF组（n=58），分别给予TDF或TAF治疗。比较两组治疗48周后的丙氨酸氨基转移酶（alanine aminotransferase, ALT）复常率、乙型肝炎病毒（hepatitis B virus, HBV）DNA转阴率；比较两组治疗前、治疗24周后及48周后血脂四项[甘油三酯（triglycerides, TG）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）、总胆固醇（total cholesterol, TC）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）]、体质量指数（body mass index, BMI）、空腹血糖（fasting blood glucose, FBG）及肝功能[ALT、天门冬氨酸氨基转移酶（aspartate aminotransferase, AST）、总胆红素（total bilirubin, TBIL）]水平。结果 治疗48周后，两组ALT复常率及HBV DNA转阴率比较，差异无统计学意义（均P>0.05）；血脂方面，TDF组治疗24周后TG、LDL-C水平低于TAF组[（1.14±0.12）mmol/L vs.(1.37±0.15)mmol/L;(3.08±0.51)mmol/L vs.(3.71±0.62)mmol/L],HDL-C水平高于TAF组[（1.46±0.33）mmol/L vs.(1.32±0.28)mmol/L]；治疗48周后，TDF组上述指标进一步改善[TG:(1.08±0.09)mmol/L,LDL-C:(2.82±0.46)mmol/L,HDL-C:(1.58±0.38)mmol/L]，而TAF组血脂水平较前恶化[TG:(1.49±0.16)mmol/L,LDL-C:(3.75±0.64)mmol/L,HDL-C:(1.33±0.31)mmol/L]，两组间各时间点血脂指标比较，差异均有统计学意义（P<0.05）；治疗24周及48周后，TDF组与TAF组TC水平差异无统计学意义（P>0.05）。代谢指标方面，TDF组治疗24周及48周后的BMI、FBG水平均低于TAF组同期水平（P<0.05）。肝功能方面，两组治疗24周及48周后的ALT、AST、TBIL水平均较治疗前显著改善（P<0.05），但组间比较差异无统计学意义（P>0.05）。结论 TAF与TDF均可有效抑制HBV复制、延缓CHB病情进展，促进肝功能改善。且相较于TAF,TDF可用于改善血脂异常CHB患者血脂水平。
Abstract：Objective To investigate the effects of tenofovir disoproxil fumarate(TDF) and tenofovir alafenamide fumarate(TAF) on lipid metabolism in patients with chronic hepatitis B(CHB) complicated with dyslipidemia. Methods A total of 116 CHB patients who needed antiviral therapy and had dyslipidemia at baseline in Yuncheng Central Hospital from March 2022 to March 2023 were selected as the study subjects. The patients were divided into TDF group(n=58) and TAF group(n=58) using random number table, and received TDF or TAF treatment respectively. The recovery rate of alanine aminotransferase(ALT) and the hepatitis B virus(HBV) DNA loss rate after 48 weeks of treatment were compared between the 2 groups. The levels of 4 blood lipids [triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C)], body mass index(BMI), fasting blood glucose(FBG) and liver function [ALT, aspartate aminotransferase(AST), total bilirubin(TBIL)] were compared between the 2 groups before treatment, 24 weeks after treatment and 48 weeks after treatment. Results After 48 weeks of treatment, there was no statistically significant difference in the ALT normalization rate and HBV DNA undetectable rate between the 2 groups(P>0.05). Regarding lipid profiles, at 24 weeks of treatment, the levels of TG and LDL-C in the TDF group were lower than those in the TAF group [TG:(1.14±0.12) mmol/L vs.(1.37±0.15) mmol/L; LDL-C:(3.08±0.51) mmol/L vs.(3.71±0.62) mmol/L], while the HDL-C level was higher than that in the TAF group [HDL-C:(1.46±0.33) mmol/L vs.(1.32±0.28) mmol/L]. After 48 weeks of treatment, the aforementioned indicators further improved in the TDF group [TG:(1.08±0.09) mmol/L, LDL-C:(2.82±0.46) mmol/L, HDL-C:(1.58±0.38) mmol/L], whereas the lipid levels in the TAF group worsened compared to the previous time point [TG:(1.49±0.16) mmol/L, LDL-C:(3.75±0.64) mmol/L, HDL-C:(1.33±0.31) mmol/L]. The differences in lipid parameters between the 2 groups at each time point were statistically significant(P<0.05). In terms of metabolic indicators, the BMI and FBG levels in the TDF group were lower than those in the TAF group at both 24 and 48 weeks of treatment(P<0.05). After 24 and 48 weeks of treatment, there was no statistically significant difference in TC levels between the TDF group and the TAF group(P>0.05). Regarding liver function, the levels of ALT, AST, and TBIL in both groups were significantly improved at 24 and 48 weeks of treatment compared with baseline(P<0.05), but there were no statistically significant differences between the 2 groups(P>0.05). Conclusion Both TAF and TDF can effectively inhibit the HBV replication, delay the progression of CHB, and promote the amelioration of liver function. Notably, compared with TAF, TDF can be used to improve the blood lipid levels of CHB patients with abnormal blood lipids.
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基本信息:
中图分类号:R512.62
引用信息:
[1]张茜,吕竹洁,常李军.TDF与TAF对血脂异常CHB患者脂代谢的影响[J].传染病信息,2026,39(02):117-121+130.
基金信息:
山西省运城市中心医院院级课题(YJB2024041); 山西省科学技术研究与开发项目(202201D916270)
2026-04-30
2026-04-30