Abstract: Objective To study the application value of real-time shear wave elastography (SWE) combined with serum hyaluronic acid (HA) and aspartate aminotransferase and platelet ratio index (APRI)in the evaluation of fibrosis degree in patients with chronic hepatitis B.Methods There were 116 cases of clinical dataes with chronic hepatitis B from June 2018 to June 2020,all patients underwent liver biopsy,the grade of liver fibrosis was recorded.All patients were examined by SWE and the elastic modulus was recorded.The serum hyaluronic acid (HA) was detected by radioimmunoassay,the APRI index was calculated.The accuracy of elastic modulus, serum HA and APRI in evaluating liver fibrosis were analyzed.Results There were 48 cases of S0-S1, 32 cases of S2, 20 cases of S3 and 16 cases of S4.There were significant differences in four groups of patients with different degrees of liver fibrosis in elastic modulus [(7.2±2.4)kPa,(8.9±3.0)kPa,(13.6±5.3),(18.7±6.5)kPa,P<0.05],serum HA[(139.1±72.8)μg/L,(337.6±115.2)μg/L,(416.2±136.5)μg/L,(584.2±162.6)μg/L,P<0.05],APRI[(0.4±0.2),(0.7±0.3),(0.9±0.4),(1.1±0.5),P<0.05].The re-ceiver operative characteristic curve(ROC) analysis showed that modulus of elasticity (AUC=0.765, 95% CI=0.642-0.889), serum HA (AUC = 0.797, 95% CI = 0.680-0.913) and APRI (AUC=0.732, 95% CI=0.599-0.866) had high application value in judging liver fibrosis ≥ S2 stage.The multiple stepwise regression analysis showed that the elastic modulus, serum HA and APRI were closely related to the degree of liver fibrosis in patients with chronic hepatitis B (P<0.05).The sensitivity and specificity of elastic modulus value + HA + APRI of combined diagnosis predicts liver fibrosis ≥ S2 stage were 60.1% and 90.5% respectively,the sensitivity and specificity of elastic modulus value+HA+APRI in predicting liver fibrosis ≥ S2 stage were 92.5% and 66.5%, respectively.Conclusion The SWE combined with serum HA and APRI index has high accuracy in evaluating the degree of liver fibrosis in patients with chronic hepatitis B.

Key words: Ultrasonic shear wave imaging, Serum HA, APRI index, Chronic hepatitis B, Liver fibrosis