Chronic hepatitis B (CHB) mainly causes cirrhosis and hepatocellular carcinoma (HCC). Metabolic fatty liver disease (MAFLD) has become the most common chronic liver disease worldwide with the continuous changes in lifestyle and dietary patterns and the increase in the number of obese individuals. Consequently, the incidence rate of CHB combined with MAFLD is rapidly increasing. However, the pathogenesis, treatment, and clinical prognosis remain unclear due to the interaction between CHB and MAFLD. Notably, in the academic community, there are still controversies as to whether patients with CHB and MAFLD should immediately start antiviral treatment, whether MAFLD affects the antiviral efficacy in CHB patients, and whether nucleos(t)ide analogues (NAs) affect the body's metabolism. This article reviews the epidemiology, clinical prognosis, treatment management strategies (especially the antiviral efficacy of NAs drugs), and NAs drug effects on the body's metabolism in patients with CHB combined with MAFLD so as to provide diagnostic and therapeutic concept for clinicians.
慢性乙型肝炎（CHB）是导致肝硬化、肝细胞癌（HCC）的主要原因。随着生活方式、饮食模式的不断改变和肥胖人数的增加，代谢功能障碍相关脂肪性肝病（MAFLD）也成为全球常见的慢性肝病。CHB合并MAFLD的发病率正迅速增长，目前CHB和MAFLD在发病机制、治疗和临床预后之间的相互作用尚不明确。此外，CHB合并MAFLD患者是否应该即刻启动抗病毒治疗，MAFLD是否影响CHB患者抗病毒疗效，核苷（酸）类似物（NAs）是否影响机体代谢等问题，学界仍存在争议。文章从CHB合并MAFLD这部分患者的流行病学、临床预后、治疗管理策略（尤其是NAs药物的抗病毒疗效）以及NAs药物对机体代谢的影响角度进行综述，以期为临床医师提供诊疗思路。.