Abstract: Objective To determine the effectiveness of shear wave elastography (SWE) in evaluating liver stiffness measurement (LSM) to assess liver fibrosis and treatment response in patients with autoimmune hepatitis (AIH). Methods A total of 65 patients with AIH between June 2017 and October 2022 were enrolled, including 7 males and 58 females, averagely aged 57 (41, 73) years. The diagnosis of AIH met the requirements. According to METAVIR classification, AIH liver fibrosis was classified into stages. Standardized treatment was prednisone combined with or without azathioprine. The clinical data of AIH before and after treatment was compared, and the predictive value of LSM for AIH liver fibrosis staging was analyzed using the ROC curve. Results Among the 65 patients with AIH, there were 16 cases in F1, 21 cases in F2, 15 cases in F3 and 13 cases in F4 stages, respectively. The PLT and Alb of patients with stage F1 AIH were 238 (193, 420) ×10⁹/L and 41.2 (38.0, 43.3) g/L, compared with F2 [194 (130, 253) ×10⁹/L, 37.4 (36.2, 40.4) g/L], F3 [167 (92, 233) ×10⁹/L, 37.0 (35.1, 39.0) g/L] and F4 [118 (74, 170) ×10⁹/L, 34.4 (32.2, 37.1) g/L], F3 [167 (92, 233) ×10⁹/L, 37.0 (35.1, 39.0) g/L], with statistically significant difference (P<0.05). The APRI, FIB-4 and LSM of patients with F1 AIH were 2.6 (1.7, 4.1), 3.0 (2.0, 4.5) and 7.2 (5.0, 9.7) kPa, compared with F2 [4.4 (2.8, 6.8), 6.4 (3.4, 8.3) and 12.7 (7.7, 15.3) kPa], F3 [5.7 (3.0, 7.2), 9.3 (5.8, 13.2) and 13.0 (9.2, 18.7) kPa] and F4 [2.3 (1.4, 3.8), 8.7 (6.4, 12.9) and 15.4 (13.3, 21.5) kPa], with statistically significant difference was (P<0.05). The AUC value of LSM in diagnosis of hepatic fibrosis of AIH in stage ≥F2 and F4 was significantly higher than that of APRI and FIB-4(P<0.05). The cut-off point and AUC value of LSM in diagnosis of AIH liver fibrosis in stage ≥F2 were 8.7 kPa and 0.90 (0.81-0.96), respectively. The cut-off point and AUC value of diagnosis of liver fibrosis in F4 AIH were 13.6kPa and 0.85(0.75-0.93), respectively. Among 65 patients with AIH, 43 patients received steroid therapy and 22 patients did not. Compared with the baseline, both the steroid group and non-steroid group showed significant decreases in ALT and AST during follow-up (P<0.05). Furthermore, the steroid group showed significant decreases in APRI, FIB-4 and LSM [0.6 (0.4, 0.8), 3.3 (1.4, 4.9) and 7.5 (3.2, 9.4) kPa, P<0.05]. However, there was no significant difference in APRI, FIB-4 and LSM at baseline and follow-up in non-steroid group (P>0.05). Conclusion SWE is an effective method to evaluate liver fibrosis in AIH patients. LSM can be used as a reliable parameter to evaluate the response of AIH upon the treatments.

Key words: Autoimmune hepatitis, Shear wave elastography, Liver stiffness measurement, Prednisone, Receiver operating characteristic curve