Abstract: Objective To evaluate the predictive value of liver stiffness measurement (LSM) with two-dimensional shear wave elastography (2D-SWE) for liver related events (LREs) in chronic hepatitis B (CHB) patients. Methods A total of 476 CHB patients were selected from May 2014 to October 2020, They were divided into a LREs group (n=68) and a non-LREs group (n=408) according to whether the patient developed LREs. LREs are defined as liver decompensation, hepatocellular carcinoma and/or liver-related death. Univariate and multivariate analysis were performed to determine the independent predictive factors related to the occurrence of LREs in CHB patients, ROC curve was drawn and the diagnostic cutoff point was taken at the maximum Jordan index. The diagnostic index were calculated. Results The age of LREs group and non-LREs group was(57.6±7.4)and (49.3±9.2) years, respectively, and there was significant difference between these two groups (P<0.05). The numbers of patients of Child-Pugh A, B and C grades were 2 cases (2.9%), 20 cases (29.4%) and 46 cases (67.6%) in LREs group, and 146 cases (35.8%), 221 cases (54.2%) and 41 cases (10.0%) respectively in non-LREs group. The difference was statistically significant (P<0.05). The levels of ALT, AST, PLT and HBeAg in LREs group were(68.5±79.6)IU/L,(56.1±63.6)IU/L,(112.8±48.0)×10⁹/L,49 cases(72.0%),respectively, which were significantly higher than those in non-LREs group [(144.1±126.0) IU/L, (132.8±130.5) IU/L, (165.4±56.4)×10⁹/L, 208 cases (51.0%), respectively,all P<0.05]. LSM, APRI and FIB-4 in LREs group were (26.6±10.7) kPa, (1.0±0.4) and (2.1±1.3), respectively,which were significantly higher than those in non-LREs group [(16.4±11.8)kPa, (0.5±0.2) and (1.2±0.2), respectively, all P<0.05]. The above variants were included in multivariate analysis, and the results showed that Child-Pugh grade, LSM, APRI and FIB-4 were independent predictors of LREs in CHB patients. The AUC value of LSM (0.88) for the diagnosis of LREs in CHB patients by 2D-SWE was significantly higher than those of APRI (0.74) and FIB-4 (0.78) (P<0.05). When triply combined these parameters, the diagnostic sensitivity, specificity and accuracy were 89.7% (61/68), 94.8% (387/408) and 94.1% (448/476), respectively. Conclusion 2D-SWE measurement of LSM can effectively predict the occurrence of LREs in CHB patients. When combined with APRI and FIB-4, the diagnostic efficiency is further improved, which has value of clinical application.

Key words: Chronic hepatitis B, Two-dimensional shear wave elastography, Liver stiffness measurement, Liver-related events