Abstract: Objective To evaluate the diagnostic efficacy of liver and spleen stiffness measurement (LSM, SSM) combined with common liver fibrosis indexes APRI and FIB-4 in chronic hepatitis B (CHB). Methods 117 patients with CHB diagnosed and treated in our hospital between May 2021 and May 2024 were collected. LSM and SSM were examined by acoustic palpation elastography (STE), and serum aspartate aminotransferase and platelet ratio index (APRI) and liver fibrosis factor 4 index (FIB-4) were calculated through the detection of blood biochemical indexes. Liver fibrosis was evaluated according to METAVIR scoring system. The CHB patients were divided into a non-significant and a significant liver fibrosis groups, The clinical data, LSM, SSM, APRI and FIB-4 data of these two groups of patients were compared. The risk factors of significant liver fibrosis were analyzed, and the efficacy of each index in diagnosing different stages of liver fibrosis was evaluated by ROC curve analysis. Results Among 117 patients with CHB, there were 13 cases, 32 cases, 36 cases, 24 cases and 12 cases in F0 to F4 stages, respectively. The clinical data of patients with non-significant (≤F1 stage, N=45) and significant (≥F2 stage, N=72) liver fibrosis were compared. The PLT, ALT, AST, LSM, SSM, APRI and FIB-4 in the liver fibrosis group were (106.1±34.0) ×10⁹/L, (66.1±10.4) U/L, (61.4±12.5) U/L, (13.1±1.7) kPa, (23.1±3.7) kPa, (2.3±0.5), and (1.8±0.4), respectively, compared with those of (160.5±23.4) ×10⁹/L, (51.4±9.8) U/L, (46.8±10.1) U/L, (9.2±1.5) kPa, (15.4±3.2) kPa, (1.1±0.3), (1.0±0.3) in the non-significant hepatic fibrosis group, the difference was statistically significant (P<0.05). Taking these differences as independent variables and significant hepatic fibrosis as dependent variables, the results showed that LSM, SSM, APRI and FIB-4 were significantly associated with the occurrence of significant hepatic fibrosis in CHB patients (P<0.05). The diagnostic AUC values of LSM+SSM, LSM+SSM+APRI+FIB-4 were significantly higher than those of LSM, SSM, APRI and FIB-4 individually (P<0.05), and the diagnostic AUC value of LSM+SSM+APRI+FIB-4 was also significantly higher than that of LSM+SSM (P<0.05). The diagnostic AUC value, the sensitivity and specificity of LSM+SSM were 0.85, 88.9% and 90.3%, respectively. The diagnostic AUC value, the sensitivity and specificity of LSM+SSM+APRI+FIB-4 were 0.93, 93.3% and 91.7%, respectively. Conclusion Using STE to detect LSM and SSM in patients with CHB can effectively evaluate the status of liver fibrosis, and it is more effective when combined with APRI and FIB-4, which is worth of further study as a non-invasive diagnostic method.

Key words: Chronic hepatitis B, Sound touch elastography, Liver stiffness measurement