Research On The Relationship Between Serum Hypersensitivity C-reactive Protein Level And TCM Syndrome Types In Chronic Hepatitis B Patients

Objective In patients with chronic hepatitis B(CHB)as the research object,the study is focused on the expression level of serum hypersensitive c-reactive protein in different TCM syndrome types and explore the relationship of those above through cross sectional study in order to provide new objective index of TCM syndrome differentiation and classification to eventually improve the accuracy of TCM clinical syndrome differentiation and treatment.Methods A total of 165 CHB patients confirmed by liver biopsy were enrolled in this study.They were divided into five groups:dampness-heat(n = 53),liver depression and spleen deficiency(n = 66),liver-kidney yin deficiency(n = 18),blood-stasis obstruction(n =14),or spleen-kidney yang deficiency(n = 14)according to 2017 edition of the Standards of TCM Syndrome Differentiation for Viral Hepatitis and their serum hs-CRP were measured by immuno-nephelometry.Various non-parametric test method was adopted in this study.The expression level of hs-CRP in different TCM syndrome types in chronic hepatitis B patients and its relationships with TCM syndrome type,age,sex,serum HBV DNA level,HBVM,liver function index(ALT,AST)and liver biopsy pathological changes were observed.Results(1)There was a significant difference in the distribution of serum hs-CRP level among different TCM syndrome types.The level of serum hs-CRP in the damp-heat group and blood-stasis obstruction were higher than those of other groups.(2)The results showed that the expression level of serum hs-CRP in dampness-heat group was significantly different than that of other 4 types(P<0 001).The expression level of serum hs-CRP in blood-stasis obstruction type was significantly different with the other 4 types(P<0 001).There was a statistically significant difference between liver-kidney yin deficiency syndrome and liver-stagnation-spleen deficiency syndrome in terms of expression level of serum hs-CRP(P<0.001).(3)The following sequence is sorted by the level of serum hs-CRP in defferent groups:blood-stasis obstruction>damp-heat syndrome>liver stagnation and spleen deficiency syndrome.(4)There was a significant difference in the distribution of serum hs-CRP in hepatic inflammation grade and fibrosis stage.Among them,there was a significant difference between grade 1 and grade 3,grade 4;grade 2 and grade 3,grade 4(P<0.001)in hepatic inflammation.There was a significant difference between stage 1 and stage 4 in hepatic fibrosis stage(P=0.002).(5)The level of hs-CRP in HBeAg-positive CHB group was higher than that in HBeAg-negative CHB group with difference having statistical significance.(Z=2.373,P=0.018)(6)There was a positive correlation between serum hs-CRP level and level of HBV DNA,ALT,AST level(0.378,0.375,0.209,P<0.001).Conclusion(1)With the aggravation of hepatic inflammation and fibrosis,the lesion site and TCM syndrome type gradually spread out from qi-aspect to blood-aspect and the level of CRP elevated.(2)It is found that the level of serum hs-CRP has certain reference value in judging the severity of hepatic inflammation and fibrosis but could not offer more accurate reflection on the degree of disease progression.(3)The inflammation and body immuniy is more active in Chronic hepatitis B patients with dampness-heat syndrome or blood stasis obstruction,which suggests that the status of inflammation,immune response and battle between vital-qi and pathogenic factors differ in different TC-M syndrome types.CRP could be considered as a reference index in order to seize the right timing and opportunity of treatment.(4)Serum CRP could become a supplementary reference index for evaluation of chronic hepatitis B inflammation and may be related to the duration of chronic hepatitis B.