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乙型肝炎病毒（HBV）感染是我国慢性肝炎常见的病因之一，积极的抗病毒治疗可有效地降低失代偿期肝硬化、肝衰竭和肝癌等终末期肝病的发生风险。目前国际和国内慢性乙型肝炎防治指南，对丙氨酸转氨酶（ALT）正常的慢性HBV感染者均建议定期随访。但研究显示出有相当高比例（25.4%～88.9%）的慢性HBV感染者，虽然ALT水平始终正常，但肝脏组织学显示已存在明显的炎症、纤维化（G≥2和/或S≥2），甚至出现肝硬化和肝癌。ALT正常的慢性HBV感染者中疾病进展的过程较为隐匿，现对其过程中的相关危险因素进行介绍。“,”Hepatitis B virus (HBV) infection is one of the common causes of chronic hepatitis in China. Active antiviral therapy can effectively reduce the occurrence risk of end-stage liver diseases, such as decompensated cirrhosis, liver failure and hepatocellular carcinoma. The existing international and domestic guidelines for the prevention and treatment of chronic hepatitis B recommends regular follow-up for patients with normal alanine aminotransferase (ALT). Studies have shown that a high percentage (25.4%-88.9%) of patients with chronic HBV infection have normal ALT levels; however, hepatic histopathology revels obvious inflammation, fibrosis (G≥2 and/or S≥2), cirrhosis and liver cancer. In this paper, we reviewed the relatively insidious risk factors associated with the progression of chronic HBV infection in patients with normal ALT.