Abstract: Objective The aim of this study was to investigate diagnosis of liver fibrosis by shear wave elastography (SWE) in combination with aspartate aminotransferase to alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI) and fibrosis index based on 4 factors (FIB-4) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were enrolled in our hospital between January 2022 and June 2024, and all received liver biopsies and SWE examination for Young’ s modulus. AAR, APRI and FIB-4 were calculated, routinely. Multivariate Logistic regression analysis was applied to analyze factors affecting significant liver fibrosis (SLF) in patients with CHB. Receiver operating characteristic curve (ROC) with the area under the curve (AUC)was performed to assess diagnostic performance. Results Of the 121 patients with CHB, liver histo-pathological examination showed liver fibrosis F0 stage in 11 cases and F1 stage in 36 cases (non-SLF in 47 cases),F2 stage in 40 cases and F3 stage in 19 cases (SLF in 59 cases) and F4 stage in 15 cases; the Young’ s modulus, AAR, APRI and FIB-4 in patients with SLF were (11.5±3.1)kPa, (1.4±0.5),(1.1±0.5) and (2.2±0.8), all significantly greater than [(6.8±2.8)kPa, (1.0±0.3),(0.6±0.2) and (1.5±0.6), respectively, P<0.05] in those with non-SLF; multivariate Logistic regression analysis showed that Young’ s modulus(OR=4.389, 95% CI:2.059-9.352),AAR(OR=2.342, 95% CI:1.355-4.046),APRI(OR=3.916, 95% CI:1.892-8.102) and FIB-4(OR=1.306, 95% CI:1.042-1.636) were all the independent impacting factors for SLF in patients with CHB ; ROC analysis demonstrated that the AUC was 0.950(95% CI:0.916-0.984), with sensitivity of 90.5% and specificity of 80.9%, when combination of Young’ s modulus, AAR, APRI and FIB-4 were applied to predict SLF in patients with CHB, much superior to any one index did(P<0.05). Conclusion Application of SWE in combined with other non-invasive parameters could helpscreen and assessment liver fibrosis in patients with CHB, which needs further clinical investigation.

Key words: Hepatitis B, Liver fibrosis, Shear wave elastography, Aspartate aminotransferase to alanine aminotransferase ratio, Aspartate aminotransferase to platelet ratio index, Fibrosis index based on 4 factors, Diagnosis