目的 探讨PEG-IFNα-2b分别联合艾米替诺福韦（TMF）与富马酸替诺福韦（TDF）对治疗乙肝肝纤维化的临床疗效和常见不良反应的观察研究，为慢乙肝治疗提供更多临床参考。 方法 选取2022年 1月至2023年6月昆明市第三人民医院收治的慢乙肝肝纤维化患者130例。分为TMF联合组与TDF联合组，比较2组患者在治疗48周后的病毒下降水平和病毒应答率、肝纤四项、瞬时弹性成像（FibroScan）等指标变化，比较治疗前后肝纤维化分级变化以及不良反应发生情况。 结果 在治疗48周后，在HBV DNA转阴率、HBeAg血清学转换率方面，TMF联合组较TDF联合组显著升高，差异有统计学意义（P < 0.05），2组患者的HBsAg转阴率差异无统计学意义（P > 0.05）。治疗48周后，TMF联合组在降低HA、PCⅢ、Ⅳ-C、LN水平上疗效更显著，差异有统计学意义（P < 0.05）；在治疗48周后，2组患者肝脏组织学纤维化程度均有改善，相较TDF联合组，TMF联合组对组织学改善疗效更为显著。治疗48周后血脂异常、甲功能异常、腹泻方面，TMF联合组发生率高于TDF联合组（P < 0.05）；治疗48周后在牙龈出血、贫血、血小板减少方面，两组患者发生率差异无统计学意义（P > 0.05）；治疗48周尿酸升高、关节痛方面，TDF联合组发生率高于TMF联合组（P < 0.05）。 结论 TMF联合PEG-IFNα-2b对慢性乙型病毒性肝炎的临床疗效更优，抗病毒能力强，可更大程度抑制肝纤维化，且药物安全性良好，更利于改善预后，可为乙肝临床治愈提供更有效的用药依据。

Objective This study is to explore the clinical efficacy and common adverse reactions of PEG?IFN α ?2b combined with TMF and TDF in the treatment of hepatitis B liver fibrosis， and provide more clinical reference for the treatment of chronic hepatitis B. Methods From January 2022 to December 2023， we selected 130 patients with chronic hepatitis B liver fibrosis who were admitted to Kunming Third People's Hospital. Divided into TMF combined group and TDF combined group， the virus reduction level， virus response rate， liver fibrosis four items， instantaneous elastography （FibroScan） and other indicators were compared between the two groups of patients after 48 weeks of treatment. The changes in liver fibrosis grading and adverse reactions before and after treatment were also compared. Results After 48 weeks of treatment， the TMF combined group showed a significant increase in HBV DNA seroconversion rate and HBeAg seroconversion rate compared to the TDF combined group， with statistical significance （P < 0.05）. However， there was no statistically significant difference in HBsAg seroconversion rate between the two groups of patients （P > 0.05）. After 48 weeks of treatment， the TMF combined group showed more significant efficacy in reducing the levels of HA， PC Ⅲ， Ⅳ?C， and LN， with a significant difference （P < 0.05）； After 48 weeks of treatment， both groups of patients showed improvement in the degree of liver tissue fibrosis. Compared with the TDF combined group， the TMF combined group had a more significant effect on tissue improvement. After 48 weeks of treatment， the incidence of dyslipidemia， hypothyroidism， and diarrhea was higher in the TMF combined group than in the TDF combined group （P < 0.05）； After 48 weeks of treatment， there was no statistically significant difference in the incidence of gingival bleeding， anemia， and thrombocytopenia between the two groups of patients （P > 0.05）； The incidence of elevated uric acid and joint pain in the TDF combined group was higher than that in the TMF combined group after 48 weeks of treatment （P < 0.05）. Conclusion TMF combined with PEG?IFN α ?2b has better clinical efficacy in treating chronic hepatitis B， strong antiviral ability， greater inhibition of liver fibrosis， good drug safety， better prognosis， and can provide more effective medication basis for clinical cure of hepatitis B.