目的 探讨肝细胞脂肪变对慢性乙型肝炎(chb)患者肝纤维化进展的影响.方法 对2007年1月至8月未经治疗的562例chb患者进行肝组织穿刺活检,同时记录人口学资料并留取空腹静脉血样,分析肝组织纤维化程度与炎性反应程度、脂肪变、人口学特征、hbv dna以及生化学指标间关系.结果 在562例chb患者中,男405名,女157名,平均年龄(31.3±9.6)岁,体质量指数(bmi)为(22.2±3.1)kg/m2.hbeag(+)和hbv dna(+)分别为394例和494例.组织病理显示肝细胞脂肪变发生率为18.15%(102/562),多元回归分析表明chb患者肝细胞脂肪变的发生与bmi、tg、载脂蛋白(apo-b)、尿酸(ua)和空腹血糖(fsg)密切相关.炎性反应、肝细胞脂肪变、年龄、hbv dna拷贝量、bmi、ua、谷氨酰转移酶(ggt)是chb患者肝组织纤维化进展的相关因素.结论 代谢紊乱是chb患者肝细胞脂肪变发生的主要原因,而肝细胞脂肪变是chb患者肝组织纤维化进展相关的独立危险因素.; abstract：; objective to evaluate the prevalence of hepatic steatosis in patients with chronic hepatitis b (chb) and the impact of hepatic steatosis on the progress of fibrosis. methods five hundred and sixty two untreated chb patients (405 males and 157 females) with an average age of 31.3 underwent liver biopsy from january to august 2007. on the day of liver biopsy, a questionnaire was completed and a blood sample was obtained for laboratory analysis. the degree of liver steatosis, necroinflammation and fibrosis was assessed; demographic information and clinical data including age, gender, body mass index (bmi), history of diabetes mellitus, hypertension, dyslipidemia, and hbeag status, hbv dna viral load were documented. results in 562 patients, 102 (18. 2% ) had steatosis. multivariate analysis demonstrated that liver steatosis was associated with the levels of tg, apo-b, ua, fsg, and higher bmi; and the progress of fibrosis was associated with high degree of hepatic steatosis and necroinflammation, age over 35 years, hbv dna > 103 copies/l, high bmi and ggt. conclusions the results show that obesity and dyslipidemia in chb patients are associated with the hepatic steatosis, and the latter seems to be an important determinant for fibrosis.