Abstract: Objective To predict the hepatic pathological gradings and stagings by serum cholinesterase （Che）activity in patients with chronic hepatitis B. Methods 419 consecutive patients with chronic hepatitis B were enrolled in the present study，and their hepatic pathological diagnosis were made and serum Che activity were determined. Results There were significant differences of serum Che activity between G1 and G2，G2 and G3，G3 and G4（P＝0.000，0.000，0.014）；There were significant differences of serum Che activity between S2 and S3，and S3 and S4（P＝0.000，0.000）；The accurate rates by Che were 55.65% for G1，28.25% for G2，27.83% for G3，and 66.67% for G4；and 43.33% for S0，6.49% for S1，19.01% for S2，31.11% for S3，and 71.29% for S4；The areas under ROC curve of serum Che activity for diagnosing G4 and S4 were 0.868 and 0.831（P＝0.000 and0.000）；The optimal cutoff value of serum Che activity for prodicting G4 and S4 were no more than 5.235×103u/L and 5.535×103u/L，respectively，and the sensitivity，specificity，and accuracy were 1.000 and 0.822，0.678 and 0.758，and 0.687 and 0.771，respectively. Conclusion Serum Che activity is an index for prodicting G4 and S4 in patients with chronic hepatitis B.

Key words: Hepatitis B, Cholinesterase, Pathology, Non-invasive diagnosis