Abstract: Objective To explore the value of sonographic and elastographic feature analysis in the diagnosis and severity assessment of hepatitis B-related liver fibrosis. Methods A retrospective study was conducted, including 80 chronic hepatitis B (CHB) patients (case group) admitted to Santai County People′s Hospital from February 2022 to February 2024, and 106 healthy individuals (control group) undergoing physical examinations during the same period. All participants underwent color Doppler ultrasound to evaluate sonographic features, which were semi-quantitatively scored using a comprehensive scoring system. Liver stiffness measurement (LSM) was performed via two-dimensional shear wave elastography (2D-SWE). Serum levels of four liver fibrosis markers—hyaluronic acid (HA), type Ⅲ procollagen peptide (PⅢNP), type Ⅳ collagen (Ⅳ-C), and laminin (LN)—were detected using enzyme-linked immunosorbent assay (ELISA). Liver biopsy was performed in the case group, and patients were stratified by fibrosis stage: no fibrosis (S0, n=13), mild fibrosis (S1-S2, n=44), and significant fibrosis (≥S3, n=23). Comparisons of sonographic features, LSM, and serum fibrosis markers were made between the case and control groups, as well as among fibrosis stages. Pearson correlation analysis was used to assess relationships between sonographic features, LSM, and serum markers. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves. Results The case group exhibited significantly higher scores compared to the control group in the following parameters: liver capsule score (2.34 ± 0.56 vs. 1.12 ± 0.23 points), hepatic vein (2.12 ± 0.45 vs. 1.05 ± 0.12 points), parenchyma (2.56 ± 0.47 vs. 1.23 ± 0.31 points), margin (2.01 ± 0.34 vs. 1.00 ± 0.21 points), total score (9.03 ± 1.23 vs. 4.40 ± 0.89 points), LSM (10.23 ± 2.34 vs. 5.67 ± 1.03 kPa), and serum levels of HA (123.45 ± 23.45 vs. 78.90 ± 15.23 ng/mL), PⅢNP (56.78 ± 9.01 vs. 34.56 ± 4.56 ng/mL), Ⅳ-C (78.90 ± 12.34 vs. 56.78 ± 9.01 ng/mL), and LN (45.67 ± 8.90 vs. 34.56 ± 4.56 ng/mL) (all P<0.05). The significant fibrosis group showed higher values than the mild fibrosis group, which in turn showed higher values than the no fibrosis group (P<0.05). Positive correlations were observed between sonographic scores, LSM, and serum fibrosis markers (r=0.456, 0.478, 0.491, 0.467; r=0.432, 0.465, 0.476, 0.451; r=0.489, 0.512, 0.528, 0.503; r=0.421, 0.443, 0.459, 0.438; r=0.501, 0.534, 0.547, 0.521; r=0.523, 0.556, 0.578, 0.543; all P<0.001). ROC analysis demonstrated that the combined use of capsule, vein, parenchyma, margin, total scores, and LSM achieved an AUC of 0.820(95%CI:0.781~ 0.891) for diagnosing significant fibrosis, with sensitivity and specificity of 86.41% and 82.35%, respectively, outperforming individual parameters. Conclusion Sonographic scores and LSM increase with the progression of liver fibrosis in CHB patients and correlate positively with serum fibrosis markers. Combined diagnosis enhances the efficacy of fibrosis assessment in CHB.

Key words: Chronic hepatitis B, Liver fibrosis, Color Doppler ultrasound, Elastography, Four liver fibrosis markers