Abstract: Objective The aim of this study was to investigate the liver stiffness measurement (LSM) in patients with chronic hepatitis B viral infection and different alanineaminotransferase (ALT) levels. Methods 68 patients with chronic hepatitis B viral infections (HBV carriers in 21 and CHB in 47) were enrolled in this study between April 2018 and April 2020,and the patients were divided based on serum ALT levels into group A ( serum ALT level <40 U/L, n=21), group B (40 U/L≤ALT<80 U/L, n=24) and group C (ALT≥80 U/L, n=23). All patients underwent liver biopsies and LSM by Fibroscan. Serum hyaluronic acid (HA), laminin (LN), typeⅣ collagen (ⅣC) and type Ⅲ procollagen (PcⅢ) in the three groups were detected. The efficacy of serum ALT and LSM in predicting theexistence of significant liver fibrosis (≥S2 stage) was determined by the area under receiver operating characteristic (AUC) by MedCalc1 5.1 software. Results There were no significant differences asrespect to serum fibrosis indexes among the three groups (P>0.05); the histopathological examination showed that S₀ liver fibrosis in 24, S₁ in 13, S₂ in 13, S₃ in 10 and S₄ in 8, and there were no significant differences as respect to the distribution of different liver fibrosis among the three groups(P>0.05); the LSM in 24 individuals with S₀ liver fibrosis was (10.9±2.8)kPa, was (11.3±3.0)kPa in 13 patients with S₁, and was (12.8±3.3)kPa in 31 patients with equal to or greater than S2 liver fibrosis (P<0.05), while there were still no significant differences as respect to serum liver fibrosis indexes among thethree different liver fibrosis individuals (P>0.05); the ROC analysis demonstrated that the AUC was 0.400(SE=0.070, 95%CI=0.262-0.538, P=0.185) when serum ALT level equal to 63.8 U/L was set as the cut-off-value in predicting equal to or greater than S₂ liver fibrosis, with the sensitivity (Se) and specificity (Sp) of 0.364 and 0.370, while when the LSM equal to 12.3 kPa was set as the cut-off-value in predicting equal to or greater than S₂ liver fibrosis, the AUC was 0.868(SE=0.042, 95%CI=0.785-0.950,P=0.000), with the Se and Sp of 0.955 and 0.717. Conclusion The individuals with chronic hepatitis B viral infections might have different stage of liver fibrosis no matter how high serum ALT level, and either serum ALT levels or serum so-called liver fibrosis index, such as HA, LN,ⅣC and PcⅢ, couldn’t early warn liver fibrosis, but the LSM might do.

Key words: Hepatitis B, Hepatitis B viral carriers, Liver fibrosis, FibroScan, Diagnosis