Abstract: Objective To analyze the liver histopathological features in chronic HBV infection patients with persistently normal ALT. Methods A total of 146 chronic HBV infection patients with persistently normal ALT in our hospital were enrolled. The characteristics of liver tissue inflammation and fibrosis stage under different age groups, different serum HBV-DNA load and different serum HbeAg status were analyzed. Results The ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients over 40 years old were higher than those in patients under 40 years old (54.35% vs. 8.00%, χ²=38.688, P<0.001 and 45.65% vs. 12.00%, χ²=20.396, P<0.001); the ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients with serum HBV-DNA load>1.0×10⁷ copies/mL were higher than those with serum HBV-DNA load≤1.0×10⁷ copies/mL (29.21% vs. 12.28%, χ²=5.695, P=0.017 and 30.34% vs. 10.53%, χ²=7.795, P=0.005); the ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients with serum HBeAg (+) were lower than those with serum HBeAg (-) (9.43% vs. 30.11%, χ²=8.248, P=0.004 and 13.21% vs. 27.96%, χ²=4.198, P=0.041). The difference was statistical significant. Conclusion For the chronic HBV infection patients with persistent ALT, aged≥40 years old, serum HBV-DNA load>1.0×10⁷ copies/mL and HbeAg (-), the liver biopsy should be performed in time to avoid the optimal timing of antiviral therapy.