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血清丙氨酸转氨酶（ALT）是反映肝脏损伤的敏感且重要的指标。在慢性乙型肝炎病毒感染者中，血清ALT水平与肝脏疾病进展密切相关，是启动乙型肝炎抗病毒治疗的关键指标之一，但并不是唯一指标。ALT的正常参考范围源于健康人群的流行病学调查，在不同国家及地区或不同实验室间有所差别；而ALT的临床决策阈值则需要肝脏病专家结合疾病自然史及预后，通过大样本临床研究确立，以便用于评估肝脏损伤程度、启动治疗和评价治疗应答。“,”Serum alanine aminotransferase (ALT) is a sensitive and important marker of liver injury, which is closely related to the disease progression. It is the key rather than the only parameter to initiate treatment decisions for patients with chronic hepatitis B virus infection. The normal reference range of ALT is derived from epidemiological investigation of healthy population, which varies among different countries, regions or laboratories. Hepatologists should conduct a large number of cohort clinical studies based on the natural history and the prognosis of the disease, and adjust the cut-off value of ALT levels to make clinical decisions in order to determine the degree of liver injury, the treatment initiation and response.