Objective To investigate the predictive value of real-time shearwave elastography (SWE) in the treatment effect of patients with non-alcoholic steatohepatitis (NASH).Methods A total of 60 NASH patients with complete clinical data were selected. Before and after treatment，SWE technology was used to collect the mean values of Elasticity modulus (E-Mean) of the right lobe of liver and right kidney parenchyma. At the same time，Serological indexes such as biochemical and blood coagulation were collected and FIB-4 index was calculated. The end point of observation was 6 months，and the patients were divided into effective group and ineffective group according to the treatment effect. The differences of liver E-mean, liver and kidney E-mean ratio and FIB-4 index between the effective group and the ineffective group before treatment were compared, and the changes of them within and between the groups before and after treatment were analyzed. The ROC curve was used to evaluate the efficacy of liver E-mean and liver-kidney E-mean ratio in evaluating the prognosis of NASH patients.Results Before treatment，the liver E-Mean，liver-kidney E-mean ratio and FIB-4 index of effective group were lower than those of ineffective group (P<0.05).After treatment, the liver E-mean, liver-kidney E-mean ratio，FIB-4 index in the effective group and the FIB-4 index in ineffective group were decreased compared with before treatment (P<0.05)，while the liver E-mean and liver-kidney E-mean ratio in the ineffective group had a tendency to increase compared with before treatment (P<0.05). ROC results showed that the AUC, sensitivity, specificity and cutoff value of liver E-mean for NASH prognosis evaluation were 0.763，67%，87% and 9.93kPa, respectively. These parameters of liver-kidney E-mean ratio for NASH prognosis evaluation were 0.828, 78% , 91% and 1.89 respectively.Conclusions SWE can dynamically monitor the course of treatment in patients with NASH, and its quantitative indicators have the potential to predict treatment effect in patients with NSAH.