Abstract: Objective To investigate hepatic activity grading and fibrosis staging in hepatitis B patients with low serum hepatitis B surface antigen levels. Methods Seventy patients with low serum HBsAg levels were recruited in our hospital between March 2016 and March 2018. The liver biopsies were performed in all patients,and the Scheuer’s hepatic activity index was applied to determine the hepatic inflammation grade and fibrosis stage. Univariate and multivariate regression analysis was used to analyze the influencing factors. Results There were 26 patients （37.1%） without or with mild hepatic inflammatory grading （G₀-G₁）,and 44 patients （62.9%） with moderate to severe inflammatory grading （G₂-G₃）,and there were 37 patients （52.8%） without or with mild hepatic fibrosis （S₀-S₁） and 33 patients （47.2%） with moderate to severe hepatic fibrosis （S₂-S₃）;univariate and multivariate regression analysis showed that the duration of infection[OR=3.245,95 % confidence interval （CI）:1.210-2.012,P=0.035] and splenic vein diameter（OR=4.011,95% CI:1.248-6.514,P=0.025） were the independent risk factors affecting hepatic activity grading,and serum aspartate aminotransferase level（OR=2.225,95% CI:0.895-1.211,P=0.048） and platelet counts（OR=3.014,95% CI:0.964-1.010,P=0.021） were the independent risk factors affecting liver fibrosis. Conclusion The hepatic activity index might be increased in CHB patients with low serum HBsAg levels,suggesting that they should be given much more medical attention for appropriate management in time.

Key words: Hepatitis B surface antigen, Inflammation, Fibrosis, Influencing factors