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慢性乙型肝炎病毒（HBV）感染者由于感染的时间及机体免疫清除病毒的能力不同，可表现为病毒携带状态或慢性活动性肝炎。目前应用的抗HBV治疗药物，无论是核苷（酸）类似物，还是聚乙二醇干扰素α，只有在肝脏炎症活动时才能取得满意的疗效，而临床上评价肝脏炎症活动最敏感的指标是丙氨酸转氨酶（ALT）。因此，各国权威指南均推荐慢性HBV感染者抗病毒治疗指征为HBV DNA阳性，且ALT >正常值上限（或2倍正常值上限）。然而，大量研究显示很多ALT正常的慢性HBV感染者，由于没有及时启动抗病毒治疗，使疾病隐匿进展为肝硬化或肝细胞癌，甚至首次发作即为肝衰竭。因此，关于ALT正常的慢性HBV感染者疾病评估及治疗时机选择越来越引起重视，成为临床研究的热点问题。“,”Due to the difference in infection time and immune clearance ability, patients with chronic hepatitis B virus (HBV) infection may appear as virus carrier or chronic active hepatitis. Alanine aminotransferase (ALT) is the most sensitive biomarkers for evaluating liver inflammation. Current anti-HBV drugs, nucleoside analogues (NAs) and peginterferon α, can only achieve satisfactory results when liver inflammation is active. Therefore, international authoritative guidelines recommend HBV DNA positive and ALT > 2-fold the upper limit of normal (2×ULN) as indications for treatment. However, many studies have shown that some chronic HBV infected patients with normal ALT have insidious progression to liver cirrhosis or liver failure, because of not initiating antiviral therapy in time. Hence, the disease assessment and initiation indication for treatment have received more and more attention and become a hot topic in clinical research for chronic HBV infected patients with normal ALT.