Abstract: Objective To investigate the value of instantaneous elastic imaging combined with serum hepatitis B virus surface antigen (HBsAg) and hepatitis B virus gene (HBV DNA) in evaluating the degree of hepatitis B liver fibrosis. Methods From February 2019 to April 2023, 77 patients with chronic hepatitis B were admitted to Huainan Chaoyang Hospital. All patients received liver puncture biopsy to determine the stage of liver fibrosis, and the results showed that 14 cases were in stage S0, 20 cases were in stage S1, 21 cases were in stage S2, 13 cases were in stage S3, and 9 cases were in stage S4. The Mindray Hepatus 5 tester was used to determine the liver hardness value, and the serum HBsAg and HBV DNA levels were tested. Results The liver hardness values of S0-S1, S2, S3 and S4 stages were (6.02±1.41)kPa, (9.11±1.46)kPa, (11.26±1.38) kPa and (13.05±1.59) kPa, respectively. The liver hardness values of S4 stage were higher than those of S3 stage and S3 stage were higher than those of S2 stage. The liver hardness of S2 stage was higher than that of S0-S1 stage (P<0.05). HBsAg levels in stages S0-S1, S2, S3 and S4 were (216.81±42.09) IU/mL, (142.68±35.17) IU/mL, (53.61±11.54) IU/mL, and (26.51±8.14) IU/mL, respectively. HBV DNA in S0-S1, S2, S3 and S4 stages were (1.14×10⁶±1.79×10⁵)IU/mL,(1.06×10⁶±1.54×10⁵)IU/mL, (9.61×10⁵±1.39×10⁵) IU/mL, (8.47×10⁵±1.33×10⁵) IU/mL, respectively. HBsAg level in S0-S1 stage was higher than that in S2 stage, the level in S2 stage was higher than that in S3 stage, and the level in S3 stage was higher than that in S4 stage. HBV DNA level in S0-S1 stage was higher than that in S3 stage and S4 stage, and the level in S2 stage was higher than that in S4 stage (P<0.05). According to ROC analysis, the area under ROC curve of liver hardness value and serum HBsAg and HBV DNA in evaluating the degree of liver fibrosis ≥S2 stage were 0.829 (95%CI: 0.746~0.912), 0.747 (95%CI: 0.678~0.816) and 0.723 (95%CI: 0.778~0.816), respectively. The optimal cut-off values were 7.362 kPa, 148.306 IU/mL, 1.092×10⁶ IU/mL, the sensitivity were 0.774, 0.648, 0.679, and the specificity were 0.920, 0.837, 0.863, respectively. The area under the curve of the combined diagnosis was 0.907 (95%CI: 0.861~0.953), the sensitivity and specificity were 0.910 and 0.958, respectively, P<0.05. Conclusion Instantaneous elastic imaging and serum HBsAg and HBV DNA have good value in the evaluation of chronic hepatitis B patients with liver fibrosis degree ≥S2 stage, and the sensitivity and specificity can be further improved in the combined evaluation.

Key words: Chronic hepatitis B, Liver fibrosis, Instantaneous elastic imaging, Hepatitis B virus surface antigen, Hepatitis B virus gene