目的 分析低病毒载量HBeAg阴性不确定期慢性HBV感染者肝组织病理特征。 方法 选取2013年9月—2021年6月于延安大学附属医院感染病科行肝组织活检的271例低病毒载量HBeAg阴性慢性HBV感染者作为研究对象，比较不同年龄、性别、乙型肝炎家族史、HBsAg及ALT水平患者的肝组织损伤程度。计数资料两组间比较采用χ²检验。 结果 271例HBeAg阴性慢性HBV感染者中86例（31.73%）肝组织炎症活动度≥A2、72例（26.57%）肝纤维化分期≥F2，112例（41.33%）患者存在中、重度肝组织损伤。ALT>20 U/L患者中肝组织炎症活动度≥A2比例高于ALT≤20 U/L患者，差异有统计学意义（χ²=3.938，P=0.047）。不同年龄、性别、乙型肝炎家族史、HBsAg水平患者的肝组织炎症活动度≥A2比例差异均无统计学意义（P值均>0.05）；不同年龄、性别、乙型肝炎家族史、HBsAg水平、ALT水平患者的肝纤维化分期≥F2比例差异均无统计学意义（P值均>0.05）；进一步对年龄≤30岁和无乙型肝炎家族史患者进行分层分析，结果显示肝组织炎症活动度≥A2比例和肝纤维化分期≥F2比例的组间差异亦无统计学意义（P值均>0.05）。不同年龄、性别、乙型肝炎家族史、HBsAg水平、ALT水平等临床特征患者的肝组织损伤程度差异均无统计学意义（P值均>0.05）。 结论 超过40%的低病毒载量HBeAg阴性慢性HBV感染者肝组织存在显著损伤，不同年龄、性别、乙型肝炎家族史、HBsAg及ALT水平患者的肝组织损伤程度未见明显差异，即使年龄<30岁否认乙型肝炎家族史，患者仍有相当比例的肝组织存在损伤，需要引起临床医师的重视。

Objective To investigate the liver histopathological features of HBeAg-negative patients in the indeterminate phase of low-viral-load chronic hepatitis B virus （HBV） infection. Methods A total of 271 patients with low-viral-load HBeAg-negative chronic HBV infection who underwent liver biopsy in Department of Infectious Diseases， Affiliated Hospital of Yan’an University， from September 2013 to June 2021 were enrolled as subjects， and the degree of liver injury was compared between patients based on age， sex， presence or absence of the family history of hepatitis B， HBsAg， and alanine aminotransferase （ALT） level. The chi-square test was used for comparison of categorical data between two groups. Results Among the 271 patients with HBeAg-negative chronic HBV infection， 86 patients （31.73%） grade≥A2 liver inflammatory activity， 72 （26.57%） had a liver fibrosis stage of ive， and 112 （41.33%） had moderate or severe liver histological injury. The proportion of patients with grade≥A2 liver inflammatory activity in the patients with ALT>20 U/L was significantly higher than that in the patients with ALT≤20 U/L （χ²=3.938， P=0.047）. There were no significant differences in the proportion of patients with grade≥A2 liver inflammatory activity between the patients with different ages， sexes， family history of hepatitis B， HBsAg levels （all P>0.05），there were no significant differences in the proportion of patients with a liver fibrosis stage of ≥F2 between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels （all P>0.05）， and the stratified analysis of patients aged≤30 years and patients without the family history of hepatitis B showed no statistical significance between groups （all P>0.05）. There was no significant difference in the degree of liver histological injury between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels （all P>0.05）. Conclusion Significant liver injury is observed in more than 40% of the patients with low-viral-load HBeAg-negative chronic HBV infection， and there is no significant difference in the degree of liver histological injury between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels. Even for the patients aged≤30 years who deny the family history of hepatitis B， there is still a considerable proportion of patients with liver injury， which should be taken seriously by clinicians.