Objective: To analyze the value of transient elastography (TE) in assessing the degree of liver fibrosis and the efficacy of antiviral treatment in patients with chronic hepatitis B (CHB). Methods: A total of 186 patients with CHB who underwent TE to obtain liver stiffness measurement (LSM). According to liver biopsy results, patients were divided into the non-significant fibrosis group (F0-1), the significant fibrosis group (F2-3), and the cirrhosis group (F4). Patients with liver fibrosis ≥ F2 were given antiviral treatment and followed up for 12 months. Based on treatment response, they were further grouped. LSM values were compared among patients with different degrees of liver fibrosis and different treatment outcomes. The correlation between LSM and the degree of liver fibrosis, and the predictive efficacy for treatment effect were analyzed. Results: LSM increased with the progression of liver fibrosis (P<0.05). LSM was positively correlated with the degree of liver fibrosis (P<0.05). For the 111 patients who received antiviral treatment, the non-response group had higher LSM than the response group (P<0.05). The area under the curve of LSM in predicting the efficacy was 0.813, with sensitivity of 80.20% and specificity of 73.30%. Conclusion: TE demonstrates good value in assessing the degree of liver fibrosis and the efficacy of antiviral treatment in patients with CHB.