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BACKGROUND We aimed to explore the expression of chitinase-3-like protein 1 (CHI3L1) in different traditional Chinese medicine (TCM) syndromes and its correlation with liver fibrosis. METHODS A total of 95 patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B who were diagnosed by pathological examination of liver biopsy specimens were selected as study subjects. According to different TCM syndrome types, 47 cases were divided into damp-heat moderate resistance type, and 48 cases were liver depression and spleen-deficiency type. Serum samples of the 2 groups were collected, then the levels of CHI3L1 were detected by enzyme-linked immunosorbent assay (ELISA). Hyaluronic acid (HA), laminin (LN), fibronectin (FN), collagen type IV (CIV), and N-terminal procollagen III propeptide (PIIINP) were measured by chemiluminescence. The levels of CHI3L1 was studied to explore the correlations between the 2 types of TCM syndromes and liver fibrosis. RESULTS The serum CHI3L1 level of the 2 groups increased with increasing fibrosis stage and peaked at the S4 stage. The serum CHI3L1 levels of liver depression and spleen deficiency type patients in the S0-S1, S2-S3, and S4 stages were higher than those of patients with damp-heat moderate resistance type, and the difference was significant (P<0.01). The levels of HA, LN, FN, CIV, and PIIINP in the 2 groups increased with the increase of fibrosis stage and reached the highest level at the S4 stage. Compared to patients with damp-heat syndrome, the levels of HA, LN, FN, CIV, and PIIINP in patients with liver depression and spleen deficiency syndrome were lower, and the difference was statistically significant (P<0.05). There were positive correlations between CHI3L1 and HA, LN, FN, CIV, and PIIINP (all <0.05). CONCLUSIONS The expression level of CHI3L1 in HBeAg-positive chronic hepatitis B patients was higher than expected. The levels of CHI3L1, HA, LN, FN, CIV, and PIIINP in liver depression and spleen deficiency type patients were lower than those in damp-heat moderate resistance type patients. These findings indicated that CHI3L1 is correlated with HA, LN, FN, CIV, PIIINP liver fibrosis indexes, and the syndrome of stagnation of spleen deficiency has a better correlation.