Background and Aims: Chronic hepatitis B virus (HBV) infection is a serious health problem worldwide. Evaluating liver injury in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) with detectable HBV DNA and normal alanine aminotransferase (ALT) is crucial to guide their clinical management. We aimed to investi-gate the stages of liver inflammation and fibrosis as well as the predictive accuracy of gamma-glutamyl transpepti-dase-to-platelet ratio (GPR) in these patients. Methods: A total of 184 treatment-na?ve HBeAg-negative CHB pa-tients with detectable HBV DNA and normal ALT were en-rolled. The Scheuer scoring system was used to classify liver inflammation and fibrosis. Results: The distribution of patients with different liver inflammation grades were as follows: G0, 0 (0％); G1, 97 (52.7％); G2, 68 (37.0％); G3, 12 (6.5％); and G4, 7 (3.8％). The distribution of pa-tients with different liver fibrosis stages were as follows: S0, 22 (12.0％); S1, 72 (39.1％); S2, 42 (22.8％); S3, 19 (10.3％); and S4, 29 (15.8％). The areas under the re-ceiver operating characteristic (AUROC) curves of GPR in predicting significant inflammation, severe inflammation, and advanced inflammation were 0.723, 0.895, and 0.952, respectively. The accuracy of GPR was significantly superior to that of ALT in predicting liver inflammation. The AUROCs of GPR in predicting significant fibrosis, severe fibrosis, and cirrhosis were 0.691, 0.780, and 0.803, respectively. The predictive accuracy of GPR was significantly higher than that of aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) in identifying advanced fibrosis and cirrhosis, and it was superior to FIB-4 but comparable to APRI in identifying significant fibrosis. Conclusions: Nearly half of the HBeAg-negative CHB pa-tients with detectable HBV DNA and normal ALT levels had significant liver inflammation or fibrosis. GPR can serve as an accurate predictor of liver inflammation and fibrosis in these patients.