To analyze miR-223-3p expression in patients with hepatitis B virus (HBV) live fibrosis and its effects on proliferation, activation, and apoptosis of human hepatic stellate cell line. One hundred patients with HBV-associated liver fibrosis were divided into S0 to 1, S2 to 3, and S4 groups according to Scheuer histological staging; healthy individuals during the same period were enrolled as healthy group. Relative expressions of miR-223-3p in healthy, S0 to 1, S2 to 3, and S4 groups were 0.56 ± 0.11, 1.08 ± 0.27, 2.16 ± 0.42, and 3.59 ± 1.06, respectively. Absorbance values of human hepatic stellate cell line cells at 24, 48, and 72 hours were higher in miR-223-3p-mimic group than in control group (CG) and NC-mimic group and were lower in miR-223-3p-inhibitor group than in CG and NC-inhibitor group (P < .05). mRNA miR-223-3p, α-smooth muscle actin, collagen 1A1, collagen 1A2, collagen 3A1, and transforming growth factor (TGF)-β1 levels were higher in miR-223-3p-mimic group than in CG and NC-mimic group and lower in miR-223-3p-inhibitor group than in CG and NC-inhibitor group (P < .05). Protein expressions of α-smooth muscle actin, transforming growth factor-β1, collagen I, collagen III, p-Smad3, p-Smad2, and B-cell lymphoma 2 were higher in miR-223-3p-mimic group than in CG and NC-mimic groups and lower in miR-223-3p-inhibitor group than in CG and NC-inhibitor group, whereas those of B-cell lymphoma 2-associated death promoter, B-cell lymphoma 2 associated X protein, cleaved caspase3, cleaved caspase9, poly ADP-ribose polymerase were lower in miR-223-3p-mimic group than in CG and NC-mimic group and higher in miR-223-3p-inhibitor group than in CG and NC-inhibitor group (P < .05). HBV liver fibrosis patients had elevated expression of miR-223-3p in plasma. Upregulation of miR-223-3p expression may be related to transforming growth factor-β1/Smad signaling pathway activation.