Abstract: Objective To investigate the feature of liver pathology in chronic HBV patients with normal level of alanine aminotransferase (ALT),to analyze the risk factors of liver inflammation and fibrosis ,to determine the exact timing of antiviral treatment. Method The clinical data of 150 patients with chronic HBV infection with normal level of serum ALT in Shenzhen Hospital of Integrated Traditional And Western Medicine from September 2020 to January 2022 were retrospectively collected and the liver pathological results of all subjects were statistically analyzed. Univariate analysis and multivariate regression were used to analyze the risk factors for significant liver inflammation (G≥2) or fibrosis (S≥2). Result The pathological examination of liver tissue reveal G≥2 or S≥2 in 93 cases (62.00%). Univariate analysis showed that ALT>25U/L, glutamyl transpeptidase (GGT)>20U/L, prealbumin (PA)≤230g/L, platelet(PLT) count ≤160×10⁹/L, partial activated prothrombin time (APTT) >28s were the possible risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT (P<0.05); Multivariate analysis of binary logistic regression showed that ALT>25U/L, PLT count≤160×10⁹/L and APTT>28s were independent risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT. Conclusion ALT level, PLT level and APTT level can be used as the basis for judging the severity of liver pathology and receiving antiviral therapy in chronic HBV infected patients with normal level of ALT.

Key words: Chronic hepatitis B, Liver pathology, Alanine aminotransferase, Predictive factors