This study aimed to evaluate factors associated with significant liver histological changes. Liver biopsies from 157 CHB patients were retrospectively analyzed. Only ALB was significantly correlated with advanced liver necroinflammatory ( ). Age, ALB, GLOB, AST, PLT, and PT were independent predictors of significant fibrosis ( , , , , and resp.). AST, WBC, and HBV DNA were significantly correlated with advanced fibrosis in normal ALT patients ( , , and resp.) and age, ALB, GLOB, PLT, and PT in patients with abnormal ALT ( , , , , and resp.). Age, AST, GGT, PLT, and PT were significantly associated with advanced fibrosis in HBeAg+ patients ( , , , and resp.) and ALB, GLOB, WBC, PLT, and PT in HBeAg？ patients ( , , , and resp.). PLT was an excellent predictor for cirrhosis ( and ). ALT was not predictive of advanced fibrosis for patients with HBeAg+ or HBeAg？ ( and resp.). PLT was an excellent predictor for cirrhosis in CHB patients. Liver histopathology can be recommended for chronic HBV carriers of older age, with normal ALT, lower PLT, and lower ALB. 1. Introduction Globally, there are approximately 350–400 million people infected with chronic hepatitis B virus (CHB) [1] and in China, a high endemic area, there an estimated 93 million people infected [2]. Without treatment, 15 to 40% of people with chronic HBV develop cirrhosis with a risk of developing hepatocellular carcinoma (HCC) [3, 4]. The clinical course of chronic HBV infection ranges from an inactive carrier state to cirrhosis, hepatic decompensation, and HCC [5–7]. Fibrosis often evolves insidiously, especially in inactive HBV carriers [8]. Active inflammation appears to be the driving force for development of fibrosis [9]. Liver biopsy remains the investigation of choice for assessment of inflammation and fibrosis. Liver biopsy is recommended for certain patients with chronic HBV infection especially older patients, those with persistent HBV DNA levels above 2,000？IU/mL and ALT 1-2 × the upper limit of normal (ULN), according to the Asian Pacific Association for the Study of the Liver (APASL), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases (AASLD) [10–12]. Antiviral treatment is recommended when liver histology reveals moderate-to-severe active necroinflammation and/or significant fibrosis by METAVIR scoring [10–12]. Although liver biopsy is often essential in the management of patients with liver disease, physicians and patients are concerned about the invasive nature of the procedure and potential complications
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