Evaluation Value of Ultrasound Elastography Combined with Serum Alpha-Fetoprotein and Cholinesterase in Assessing Hepatic Fibrosis in Patients with Chronic Hepatitis B

doi:10.16458/j.cnki.1007-0893.2025.19.020

Abstract：Objective: To evaluate the value of ultrasound elastography combined with serum alpha-fetoprotein (AFP) and cholinesterase in guiding the assessment of hepatic fibrosis in patients with chronic hepatitis B. Methods: A retrospective analysis was conducted on 192 patients with chronic hepatitis B admitted to Kaifeng Hospital of Traditional Chinese Medicine from March 2023 to March 2025. According to the degree of hepatic fibrosis, the patients were divided into five groups based on the METAVIR scoring system: F0 (no fibrosis, 123 cases), F1 (minimal fibrosis, 16 cases), F2 (visible fibrosis extending beyond the vascular area, 17 cases), F3 (bridging fibrosis connecting across regions, 16 cases), and F4 (cirrhosis or obvious fibrosis, 20 cases). All patients underwent ultrasound transient elastography examination. The parameters of ultrasound examination and serum AFP and cholinesterase levels were compared among the five groups. Spearman correlation analysis was used to assess the relationship between these indicators and the degree of hepatic fibrosis. Receiver operating characteristic (ROC) curves were used to analyze the evaluation value of these indicators for patients with ≥F1, ≥F2, ≥F3, and F4 stages. Results: The liver stiffness measurement (LSM) values and serum AFP levels showed a descending order from F4 to F0 groups, while serum cholinesterase levels showed an ascending order from F4 to F0 groups. The controlled attenuation parameter (CAP) was higher in the F4 and F3 groups compared to the F1 group, and higher in the F2, F3, and F4 groups compared to the F0 group, with all differences being statistically significant (P < 0.05). Spearman correlation analysis showed that LSM values and serum AFP levels were highly positively correlated with the degree of hepatic fibrosis (r = 0.752, r = 0.649, both P < 0.05), while serum cholinesterase levels were negatively correlated with fibrosis (r = -0.605, P < 0.05). ROC curve analysis showed that LSM values, serum AFP, and cholinesterase levels had good evaluation value for F1, F2, F3, and F4 stages of hepatic fibrosis (P < 0.05). Conclusion: Ultrasound elastography combined with serum AFP and cholinesterase has good guiding value in assessing the severity of hepatic fibrosis in patients with chronic hepatitis B.