Traditional Chinese Medicine Syndrome Patterns and Their Association with Hepatitis B Surface Antigen Levels during the Natural History of Chronic Hepatitis B Virus Infection.

He-Ping Xie,Zhi-Ping Liu,Min Dai,Jiong-Shan Zhang,Wei-Kang Wu,Hong-Zhi Yang,Ge-Min Xiao

doi:10.1155/2018/7482593

Abstract

The aim of this study is to investigate traditional Chinese medicine syndrome (TCMS) patterns and their association with hepatitis B surface antigen (HBsAg) levels during the natural history of chronic hepatitis B virus infection (CHB). Patients were categorized according to the phase of CHB, as follows: immune tolerance (ITP); immune clearance (ICP); low or nonreplication (LRP); reactivation (RAP); hepatic cirrhosis (HC); and primary liver cancer (PLC). TCMS patterns were classified among the following types: spleen-kidney deficiency (SKD); liver-qi depression (LQD); damp-heat in liver-gallbladder (LGDH); liver-kidney deficiency (LKD); and blood stasis blocking collateral (BSBC). HBsAg levels and other serological indicators were quantified for all patients and their association with TCMS was statistically analyzed and determined. Two hundred and eighty-nine patients with CHB were included. During the natural history of CHB, TCMS patterns were statistically different among the different phases (P < 0.001). The most frequently occurring syndromes among the six progressive phases were SKD, LGDH, LKD, LGDH, BSBC, and LGDH, respectively. The predominant patterns in the inactive stage (ITP + LRP), active stage (ICP + RAP), and late or advanced stage (HC + PLC) were SKD (31%), LGDH (51.8%) and BSBC (34.4%), respectively. Median HBsAg levels were also statistically different among the five patterns of TCMS (P < 0.001). The highest HBsAg levels were observed in SKD (4.48 log10 IU/mL). Medium levels were in LQD (3.91 log10 IU/mL) and LGDH (3.90 log10 IU/mL). The lowest HBsAg levels were in LKD (3.60 log10 IU/mL) and the second lowest levels in BSBC (3.81 log10 IU/mL). In addition, HBsAg levels in LKD and BSBC were significantly lower than those in SKD, LQD, and LGDH (P < 0.05 or 0.001). TCMS was altered during the natural history of CHB and correlated with HBsAg titers. This study could provide further insight into the therapy of CHB.

Highlights

Due to high risk of developing acute or chronic hepatic failure and hepatocellular carcinoma (HCC), chronic hepatitis B virus (HBV) infection (CHB) remains a heavy burden and substantial challenge to global public health [1,2,3]
Two hundred and eighty-nine patients with chronic hepatitis B virus infection (CHB) were enrolled in the study and divided into the six groups, representing immune tolerance phase (ITP) (n = 70), immune clearance phase (ICP) (n = 50), reactivation phase (RAP) (n = 33), low or nonreplication (LRP) (n = 72), hepatic cirrhosis (HC) (n = 19), and primary liver cancer (PLC) (n = 45)
Nine patients with ALT < 2 × upper limit of normal (ULN), but whose ALT elevations were not associated with HBV infection, were classified as LRP

Summary

Introduction

Due to high risk of developing acute or chronic hepatic failure and hepatocellular carcinoma (HCC), chronic hepatitis B virus (HBV) infection (CHB) remains a heavy burden and substantial challenge to global public health [1,2,3]. With the widespread use of anti-HBV agents in the past decades, interferon-based regimens and nucleos(t)ide analogs, much progress has been made on the therapy of CHB. Current therapy is still limited to the suppression of viral DNA replication, and prolonged use of nucleos(t)ide analogs induces more viral mutation [4]. In. Evidence-Based Complementary and Alternative Medicine Phase ITP. ALT∗ in U/L < ULN HBeAg status +. Liver imaging normal ICP ≥ 2 × ULN + > 2000

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