Objective To explore the application value of ultrasound combined with elastography in grading inflammation in patients with chronic liver disease at S2 stage of liver fibrosis. Methods Totally 51 patients who were hospitalized at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jan. 2022 to Mar. 2024 and underwent liver biopsy with pathological results indicating a stage of S2 liver fibrosis in chronic liver disease were enrolled. All patients underwent ultrasound-guided liver biopsy to obtain the stage of pathological liver fibrosis (S1 to S4) and the grade of liver inflammation (G0 to G4). In addition, all the patients were examined by ultrasound combined with elastography; and shear wave velocity (Vs), acoustic attenuation coefficient (ATT), liver fibrosis index (LFI), fibrosis-related index (F index), and inflammatory activity index (A index) were obtained. The correlation between ultrasound combined with elastography parameters and pathological inflammation grading was analyzed. Results According to the pathological inflammation grading, there were 15 cases in group G1, 28 cases in group G2, and 8 cases in group G3. There were significant differences in F index, A index, Vs and ATT among the 3 groups (all P＜0.05). Among them, F index, A index and Vs in group G1 were significantly lower than those in group G3 (P＝0.007, 0.006, 0.040), while ATT was significantly higher than that in group G3 (P＝0.005); and there was no significant difference in LFI among the 3 groups (P＝0.373). Vs, ATT, F index and A index were correlated with pathological inflammation grade (r＝0.404, －0.417, 0.379, 0.383; P＝0.003, 0.002, 0.006, 0.006). The mean plot showed that with the increase of pathological inflammation grade, the age of patients showed a linear upward trend, ATT showed a linear downward trend, and A index showed a linear upward trend. Vs was positively correlated with alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), total bilirubin, and direct bilirubin (DBil) (all P＜0.05). ATT was negatively correlated with ALT, AST, GGT, and DBil (all P＜0.05); and both F index and A index were positively correlated with ALT, AST, ALP, GGT, and DBil (all P＜0.05). Conclusion Ultrasound combined with elastography can be used to evaluate the degree of inflammation in patients with chronic liver disease at S2 stage of liver fibrosis.