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目的:总结慢性乙型肝炎（CHB）合并自身免疫性肝炎（AIH）的临床诊断和治疗方法。方法:回顾性分析2013年12月至2018年6月上海交通大学医学院附属仁济医院消化内科门诊随访的19例诊断为CHB合并AIH患者的临床表现、实验室检查、影像学、病理组织学特点、治疗及转归情况，正态分布计量资料治疗前后比较采用配对样本n t检验；不符合正态分布的计量资料以中位数（四分位数间距）表示，治疗前后比较采用配对样本的Wilcoxon符号秩和检验。n 结果:19例患者中男性5例、女性14例，发病年龄35～63（47.10±8.76）岁。CHB先于AIH诊断有12例，AIH先于CHB诊断有5例，AIH和CHB同时诊断有2例。明确诊断CHB合并AIH后，予以核苷（酸）类似物抗乙型肝炎病毒联合糖皮质激素治疗，并根据肝内炎症（炎症分级在G3及以上）及白细胞情况加用免疫抑制剂硫唑嘌呤或吗替麦考酚酯。治疗2周至16周不等（治疗中位时间6周），除1例刚诊断治疗随访中外，其余18例患者治疗前后生物化学指标、免疫球蛋白均明显下降，治疗前后指标差异均有统计学意义（n P值均< 0.05），HBV DNA均< 20拷贝/ml。n 结论:CHB合并AIH容易漏诊，需要结合临床特点、自身抗体、免疫球蛋白水平，尤其重视肝组织病理学特点进行综合诊断。对抗-HBc阳性使用免疫抑制剂治疗的患者，应加强对HBV DNA的监测，必要时需抗乙型肝炎病毒治疗。“,”Objective:To summarize the clinical diagnosis and therapeutic method in chronic hepatitis B (CHB) combined with autoimmune hepatitis (AIH).Methods:Clinical manifestations, laboratory examination, imaging, histopathological characteristics, treatment and prognosis of 19 cases diagnosed with CHB combined with AIH followed at the outpatient Department of Gastroenterology of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine during December 2013 to June 2018 were retrospectively analyzed. Paired sample t-test was used before and after treatment for the measurement of normal distribution data. Measurement data of non-normal distribution were expressed as a median (quartile spacing) and Wilcoxon matched-pairs signed rank test was used before and after treatment.Results:Among the 19 cases, 5 were male and 14 were female. The age of onset was 35 to 63 years, and the average age was 47.10 ± 8.76 years. There were 12 cases diagnosed with CHB before AIH, 5 cases diagnosed with AIH before CHB, and 2 cases diagnosed with AIH and CHB at the same time. After the definite diagnosis of CHB combined with AIH, nucleoside (acid) analogues (antiviral against hepatitis B virus) combined glucocorticoid therapy were given, and azathioprine or mycophenolate mofetil (immunosuppressant) was added according to the intrahepatic inflammation (inflammation graded at G3 and above) and leukocyte conditions. The duration of treatment varied between 2 weeks to 16 (median treatment duration of 6 weeks), except for one case who was just diagnosed and followed up. Biochemical indicators and immunoglobulin of the remaining 18 cases before and after treatment was significantly decreased, and the differences were statistically significant (n P < 0.05), with HBV DNA < 20 copies/ml.n Conclusion:CHB combined with AIH diagnosis can be easily missed. Therefore, it requires comprehensive diagnosis combined with clinical characteristics, autoantibodies, and immunoglobulin levels with special emphasis on pathological characteristics of liver tissue. Anti-HBc-positive patients using immunosuppressant should be carefully monitored for HBV DNA and anti-HBV treatment should be given if necessary.