Abstract: Objective To analyze the clinical and histopathological features of chronic hepatitis B (CHB) patients with high HBV DNA viral load but normal or slightly elevated alanine aminotransferase (ALT) levels. Methods Three hundred and seventy-eight CHB patients aged (34.8±6.4) years including 206 males and 172 females were collected from January 2016 to September 2020. Scheuer scoring system and histological activity index were used to evaluate the stage of liver fibrosis (F0~F4) and the grade of inflammatory activity of liver tissue (G0~G4). Measurement data are analyzed by t-test; counting data were analyzed by Chi-square test. Results The age, HBV DNA load, ALT level, Aspartate aminotransferase-to-Platelet Ratio Index (APRI), and gamma-glutamyl transpeptidase to platelet ratio (GPR) for patients <F2 stage were (32.8±9.2) years, (8.4±1.0) log₁₀ copies/mL, (45.8±5.5)U/L, (0.40±0.22) and (0.12±0.07), respectively, compared with those of (35.6±5.3)years, (7.6±1.3)log₁₀ copies/mL, (56.8±7.0)U/L, (0.49±0.20) and (0.17±0.08) for patients ≥F2 stage, respectively, the difference was statistically significant (P<0.05). The age, HBV DNA, ALT, AST, FIB-4, APRI and GPR for patients<G2 stage were (33.6±8.4)years, (8.4±1.1)log₁₀ copies/mL, (46.1±5.4)U/L, (32.5±8.2)U/L, (0.19±0.11), (0.40±0.23), (0.12±0.08), respectively, compared with those of (35.2±7.5) years, (7.4±1.4)log₁₀ copies/mL, (56.0±6.8)U/L, (38.7±5.5)U/L, (0.24±0.11), (0.55±0.22), (0.17±0.10) for patients ≥F2 stage, respectively, the difference was statistically significant (P<0.05). Conclusion It is necessary to strengthen the follow-up if the CHB patients are in older age, have normal or slightly elevated ALT, but have continuously increased viral load or abnormal FIB-4, APRI and GPR. Liver biopsy need to be performed whenever necessary.

Key words: Chronic hepatitis B, Alanine aminotransferase, Liver fibrosis, Inflammatory activity of liver tissue