Department of Infectious Disease, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Ministry of Education (MOE) Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, China.
Front Immunol. 2024 Jun 4;15:1407768. doi: 10.3389/fimmu.2024.1407768. eCollection 2024.
C-reactive protein (CRP) is an acute-phase protein produced by the liver in response to infection and during chronic inflammatory disorders. Systemic inflammation is a major driver of cirrhosis progression from the compensated to the decompensated stage. Previous studies have shown that pentameric CRP (pCRP) to be a weak predictor of disease severity and prognosis in patients with decompensated hepatitis B cirrhosis, with it being only helpful for identifying patients with a higher short-term risk of death under certain conditions. Accumulating evidence indicates that pCRP dissociates to and acts primarily as the monomeric conformation (mCRP) at inflammatory loci, suggesting that mCRP may be a potentially superior disease marker with higher specificity and relevance to pathogenesis. However, it is unknown whether mCRP and anti-mCRP autoantibodies are associated with disease severity, or progression in decompensated hepatitis B cirrhosis. In this study, we evaluated the serum levels of mCRP and anti-mCRP autoantibodies in patients with decompensated cirrhosis of hepatitis B and their association with disease severity and theoretical prognosis. The results showed that patients with high mCRP and anti-mCRP autoantibody levels had more severe liver damage and that coagulation function was worse in patients with high anti-mCRP autoantibodies. Analysis of the correlation between pCRP, mCRP and anti-mCRP autoantibody levels with Model for End-Stage Liver Disease (MELD), Albumin-Bilirubin (ALBI), and Child-Turcotte-Pugh (CTP) prognostic scores showed that mCRP was the most strongly correlated with MELD score, followed by anti-mCRP autoantibodies; conversely, pCRP was not significantly correlated with prognostic score. Therefore, mCRP and anti-mCRP autoantibodies may be more advantageous clinical indicators than pCRP for evaluating the pathological state of decompensated hepatitis B cirrhosis.
C-反应蛋白（CRP）是肝脏在感染和慢性炎症性疾病时产生的急性期蛋白。全身炎症是肝硬化从代偿期向失代偿期进展的主要驱动因素。先前的研究表明，五聚体 CRP（pCRP）是失代偿性乙型肝炎肝硬化患者疾病严重程度和预后的弱预测因子，仅有助于在某些条件下识别短期死亡风险较高的患者。越来越多的证据表明，pCRP 分离并主要作为单体构象（mCRP）在炎症部位发挥作用，这表明 mCRP 可能是一种潜在的更优越的疾病标志物，具有更高的特异性和与发病机制的相关性。然而，尚不清楚 mCRP 和抗-mCRP 自身抗体是否与失代偿性乙型肝炎肝硬化的疾病严重程度或进展有关。在这项研究中，我们评估了失代偿性乙型肝炎肝硬化患者血清中 mCRP 和抗-mCRP 自身抗体的水平及其与疾病严重程度和理论预后的关系。结果表明，mCRP 和抗-mCRP 自身抗体水平高的患者肝损伤更严重，抗-mCRP 自身抗体水平高的患者凝血功能更差。分析 pCRP、mCRP 和抗-mCRP 自身抗体水平与终末期肝病模型（MELD）、白蛋白-胆红素（ALBI）和 Child-Turcotte-Pugh（CTP）预后评分的相关性表明，mCRP 与 MELD 评分相关性最强，其次是抗-mCRP 自身抗体；相反，pCRP 与预后评分无显著相关性。因此，mCRP 和抗-mCRP 自身抗体可能比 pCRP 更有利于评估失代偿性乙型肝炎肝硬化的病理状态。
