Abstract: Objective The aim of this study was to summarize the clinical clues for early liver biopsies in chronic hepatitis B viral infected individuals with low serum alanine aminotransferase (ALT) levels. Methods 226 chronic hepatitis B viral infected individuals with low serum ALT levels were admitted to our hospital between January 2017 and March 2021,and all underwent liver biopsies. The liver injuries were evaluated by Scheuer scoring system for liver fibrosis staging and by histological activity index for inflammatory activity grading. The significant liver injuries were defined as the liver fibrosis≥S2 and/or the inflammatory activity≥G2. Results Out of the 226 individuals with HBV infection and low serum ALT levels, the clinical diagnosis was chronic HBV carriers in 125 cases, and chronic hepatitis B (CHB) in 101 cases; the percentages of male, significant liver injury, serum AST >40 U/L, liver fibrosis ≥F2 and liver inflammation ≥G2 in patients with CHB were 77.2%, 61.4%, 49.5%, 36.7% and 52.5%, all significantly higher than 54.4%, 33.6%, 5.6%, 18.4% and 25.6% in HBV carriers(P<0.05); out of the 226 individuals in our series, the liver histopathological examination showed significant liver injuries in 104 cases and non-significant liver injuries in 122 cases; serum HBV DNA load in patients with significant liver injury was(4.6±1.2) lg copies/ml, significantly lower than [(5.2±1.4)lg copies/ml, P<0.05], peripheral blood platelet count was (163.6±49.2)×10⁹/L, significantly lower than [(192.2±54.5)×10⁹/L, P<0.05] in individuals without significant liver injury, and the percentages of serum ALT level greater than 40 U/L, serum AST level greater than 40 U/L, liver fibrosis greater than F2 staging and liver inflammation greater than G2 grading were 60.6%, 39.4%, 57.7% and 81.7%, significantly higher than 31.1%, 13.1%, 0.0% and 0.0%, respectively (P<0.05) in individuals without significant liver injury. Conclusion The clinical feature of individuals with chronic hepatitis B viral infection and low serum ALT levels is subtle, and some clues might hint liver injury and warrant further liver biopsy, which could present the liver histopathological grading and staging and help the clinicians to make decisions.

Key words: Hepatitis B virus carriers, Chronic hepatitis B, Alanine aminotransferase, Liver fibrosis, Histological activity index