Abstract: Objective To investigate the pathological and clinical characteristics of liver biopsy in alanine transaminase (ALT) < 2 ULN patients with hepatitis B-related liver fibrosis.To analyze the clinical value of transient elastography (FibroTouch), fibrosis-4 index (FIB-4) and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) in diagnosing progressive liver fibrosis in patients with chronic hepatitis B (CHB).Methods A total of 108 CHB patients admitted to our hospital from January 2015 to December 2019 were enrolled. General data of patients were collected. blood routine examination, liver function test and FibroTouch were performed. The FIB-4 and APRI indexes were calculated and liver biopsy was performed.Results 1. There were significant differences in AST/ALT, AST/platelets (PLT), gamma-glutamyltransferase (GGT), FibroTouch, FIB-4, APRI (PAST/ALT = 0.048, PAST/PLT = 0.032, PGGT = 0.041, PFibroTouch = 0.008, PFIB-4 = 0.003, PAPRI = 0.032) among CHB patients with different liver fibrosis degree. There were significant differences in age, PLT, AST, AST/ALT, AST/PLT, HBV DNA, Hepatitis B surface antigen quantification, FibroTouch, FIB-4, APRI (Page = 0.005, PPLT = 0.040, PAST = 0.034, PAST/ALT = 0.002, PAST/PLT = 0.005, PHBV DNA = 0.002, Psurface antigen = 0.012, PFibroTouch = 0.000, PFIB-4 = 0.000, PAPRI = 0.005) between patients with progressive liver fibrosis and patients without advanced liver fibrosis. 2. There were significant differences in AST, AST/PLT, FibroTouch, APRI (PAST = 0.000, PAST/ALT = 0.001, PFibroTouch = 0.009, PAPRI = 0.000) among patients with different liver function levels. The liver biopsy shows that among the patients with ALT < 1ULN, 33(51.56%) without progressive liver fibrosis (S < 2) and 31(48.44%) with progressive liver fibrosis (S ≥ 2 ). And among patients with 1ULN ≤ ALT < 2ULN, 26 (54.17%) without progressive liver fibrosis (S < 2) and 22(45.83%) with progressive liver fibrosis (S ≥ 2). 3. Comparing the area under the receiver operating characteristic curve (AUC), the value of FibroTouch in diagnosing progressive liver fibrosis was greater than FIB-4 and APRI indexes. The AUC of FibroTouch in diagnosing progressive liver fibrosis (S ≥ 2) was 0.73(0.63～0.82), cut-off value was 10.55kpa, sensitivity was 57%, specificity was 86%, positive predictive value was 79% and negative predictive value was 69%.Conclusion Among CHB patients with ALT < 2ULN, the proportion of which with progressive liver fibrosis (S ≥ 2) is high. FIB-4, APRI, FibroTouch have certain diagnostic value, but still cannot replace liver biopsy.

Key words: Chronic hepatitis B, Liver biopsy, Clinical features, Non-invasive liver fibrosis diagnosis