Abstract: Objective To investigate the liver pathological changes and features of hepatitis B virus( HBV) DNA in chronic HBV infection patients with normal alanine transaminase( ALT) and mild ALT elevation. Methods A total of 1123 chronic HBV infection patients with normal ALT and mild ALT elevation who were admitted to the Fifth Hospital of Shijiazhuang and had liver biopsy from January 2005 to December 2013 were retrospectively analyzed and divided into < 40 years group and ≥40 years group. The inflammation grade of liver tissue( G) and stage of fibrosis( S) among patients with positive and negative HBe Ag and with normal ALT and mild ALT elevation in the two groups were analyzed. The correlations of age with inflammation grade,fibrosis stage,and HBV DNA level were also analyzed. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test. Then Spearman correlation analysis was performed. Results Compared with the < 40 years group,the ≥40 years group had a significantly higher proportion of ≥G2 patients( P < 0. 001). Patients with normal ALT and mild ALT elevation,regardless of positive or negative HBe Ag,had a significantly higher proportion of ≥S2 individuals with increasing age( P < 0. 001). Age was positively correlated with inflammation grade and fibrosis stage( r = 0. 219 and 0. 293,P < 0. 001 for both). Compared with patients in the < 40 years group,patients with negative HBe Ag and mild ALT elevation in ≥40 years group had significantly different HBV DNA levels( P < 0. 05). Conclusion The inflammation grade of liver tissue and fibrosis stage in chronic HBV infection patients with normal ALT and mild ALT elevation increase with age,which can be considered as a factor for the progression of disease.