Abstract: Objective To explore the value of combining ultrasonic shear wave elastography (SWE) with plasma neuregulin 4 (Nrg4) levels in assessing the degree of liver fibrosis in patients with chronic hepatitis B (CHB). Methods Between June 2020 and June 2022, 116 patients with CHB-related liver fibrosis admitted to our hospital underwent liver biopsy. The liver's Young's modulus value was measured using ultrasound SWE, and the plasma Nrg4 levels were measured using the Elisa method. We analyzes the correlation between liver Young's modulus value and plasma Nrg4 levels with the degree of liver fibrosis. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was used to evaluate the diagnostic efficacy of combining Young's modulus and plasma Nrg4 levels for assessing the degree of liver fibrosis in CHB patients. Results Among the 116 patients with CHB liver fibrosis, there were 33 cases in the F1 phase (28.4%), 38 cases in the F2 phase (32.8%), 26 cases in the F3 phase (22.4%), and 19 cases in the F4 phase (16.4%). The Young's modulus values for patients in the F1, F2, F3, and F4 stages were [(5.2 ± 1.3) kPa, (6.3 ± 1.2) kPa, (8.7 ± 1.4) kPa, and (11.9 ± 1.6) kPa, respectively, P<0.05]. The plasma Nrg4 levels for patients in the F1, F2, F3, and F4 stages were [(6.7 ± 1.2) pg/mL, (4.9 ± 1.0) pg/mL, (3.3 ± 0.9) pg/mL, and (1.9 ± 0.5) pg/mL, respectively(P<0.05)]. Spearman correlation analysis showed that the Young's modulus value was positively correlated with the degree of liver fibrosis (r=0.673, P<0.05), while the plasma Nrg4 level was negatively correlated with the degree of liver fibrosis (r=-0.702, P<0.05). ROC analysis revealed the AUC values of Young's modulus for diagnosing F1, F2, F3, and F4 stages of CHB liver fibrosis were 0.85 (95% CI: 0.75-0.94), 0.83 (95% CI: 0.75-0.92), 0.86 (95% CI: 0.76-0.95), and 0.92 (95% CI: 0.82-1.00), respectively. The AUC values for plasma Nrg4 levels in diagnosing F1, F2, F3, and F4 stages were 0.86 (95% CI: 0.76-0.95), 0.82 (95% CI: 0.74-0.91), 0.88 (95% CI: 0.80-0.97), and 0.92 (95% CI: 0.82-1.00), respectively. The AUC values for diagnosing F1, F2, F3, and F4 stages using the combination of Young's modulus and plasma Nrg4 were 0.92 (95% CI: 0.84-0.99), 0.92 (95% CI: 0.85-0.98), 0.94 (95% CI: 0.88-1.00), and 0.97 (95% CI: 0.91-1.00), respectively. These combined AUC values were significantly higher than those of either Yang's modulus or plasma Nrg4 levels alone (P<0.05). Conclusion The effectiveness of Young's modulus value and plasma Nrg4 levels in diagnosing the degree of liver fibrosis in CHB is significant with the combined diagnostic value being even higher.

Key words: Chronic hepatitis B, Staging of liver fibrosis, Shear wave elastic imaging, Young's modulus value, Neuregulin 4