Abstract: Objective The aim of this study was to investigate the diagnostic value of ultrasonic elastography combined with serological indexes in evaluation of liver fibrosis in patients with chronic hepatitis B (CHB). Methods There were 358 patients with CHB enrolled in our hospital between January 2015 and June 2018, and all of them received liver biopsies, sonography for shear wave velocity (SWV) and serum HA, AST, ALT and Ⅳ-Col were assayed, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 were calculated. Multivariate Logistic regression analysis was used to analyze the independent risk factors for hepatic fibrosis occurrence, and the area under ROC curve (AUC) was used to evaluate the accuracy of each index in the diagnosis of hepatic fibrosis. Results There were 42 cases with F0, 96 cases with F1, 86 cases with F2, 72 cases with F3 and 62 cases with F4 by histopathological examination; the SWV in 220 patients with ≥F2 was (3.12±0.65)m/s, significantly higher than 【(1.72±0.51)m/s, P<0.05】 in 138 patients with ≤F1, serum HA levels was (128.1±14.7) μg/L, significantly higher than 【(75.4±10.1)μg/L, P<0.05】, the AST/ALT ratio was (0.96±0.41), much higher than 【(0.80±0.27), P<0.05】, serum Ⅳ-Col level was (36.7±14.3)μg/L, much higher than 【(24.9±9.2)μg/L, P<0.05】, the APRI score was (0.83±0.52), much higher than 【(0.61±0.49), P<0.05】, the FIB-4 index was (1.70±0.98), much higher than【(1.23±0.67), P<0.05】 in patients with ≤F1; multivariate Logistic analysis showed than SWV, AST/ALT ratio, serum HA and Ⅳ-Col levels, APRI and FIB-4 were the independent risk factors for the occurrence of hepatic fibrosis; the accuracy by SWV in diagnosis of liver fibrosis was 86.9%, by HA was 84.2%, and by APRI and FIB-4 were 82.5% and 81.8%, respectively. Conclusion SWV combined with serological markers might improve the accuracy of hepatic fibrosis diagnosis in patients with CHB, which warrants further investigation.

Key words: Chronic hepatitis B, Liver fibrosis, Sonography, Shear wave velocity, Aspartate aminotransferase to platelet ratio index, FIB-4, Diagnosis