Abstract: Objective:To elucidate the relations of the clinical features and liver histological changes of chronic hepatitis B(HBV) patients with alanine aminotransferase(ALT) less than two-time upper limits of normal(ULN).Methods:One hundred and ten cases with chronic HBV infection infection were divided into Ⅰgroup(64 cases) and Ⅱgroup(46 cases) according to the standard of ALT less than or equal to ALT1ULN and 1ULNP0.05).Among all cases,the histologic activity of liver inflammation more than or equal to grade 2 in 21.82%,the fibrosis stage of liver more than or equal to stage 2 in 29.09% and cirrhosis of liver in 19.09%(stage 4) were found.The mean age of patients with HBV DNA more than or equal to 107(copies/ml) was much younger,and their histological grade of liver inflammation and stage of fibrosis were relatively lower.The positive expressions of HBsAg and HBcAg in 81 cases liver tissue were detected by immunohistochemical staining,the differences of immunostaining scores of HBsAg and HBcAg between two groups were not statistical significance(P0.05).Conclusions:The parameters of serological and virological testing in patients with chronic hepatitis B infection couldn't fully reflect the real situation of hepatic lesions.For the older patients with longer periods,liver biopsy should be detected regardless of their ALT levels,particularly for the patients with occult cirrhosis.