目的 探讨hbeag阳性和阴性慢性乙型肝炎(chb)的临床病理学差异.方法 选择2002年6月-2010年1月在宁波市第二医院住院并做活体肝组织穿刺病理学诊断的chb患者665例,其中hbeag阳性组428例,hbeag阴性组237例,对两组患者的血清hbv dna载量、肝组织病理变化结果进行对比分析.采用spss 11.5软件进行统计学处理,计量资料采用t检验(正态分布)或mann-whitney u检验(偏态分布),计数资料用卡方检验,相关性分析采用pearson法.结果 hbeag阴性与阳性患者在肝组织炎症分级和纤维化分期的构成上差异有统计学意义(x2=7.92和10.35,p值均＜0.01),hbeag阴性组的炎症分级、纤维化分期高于hbeag阳性组.hbeag阴性患者血清hbv dna水平在＜3、≥3～＜5 log10拷贝/ml的比例明显高于hbeag阳性组(x2=105.16和36.92,p值均＜0.01),而≥7 log10拷贝/ml所占的比例较hbeag阳性组低(x2=110.18,p＜0.01).随着血清hbv dna水平的上升,hbeag阳性chb患者肝组织炎症分级和纤维化分期呈下降趋势(r=-0.287和-0.224,p＜0.01),而在hbeag阴性chb患者中则呈上升趋势(r=0.360和0.303,p＜0.01).结论 hbeag阴性chb患者肝组织损伤较hbeag阳性患者更加严重,须密切监测.; abstract：; objective to identify the differences in clinicopathological features between hbeag-positive and hbeag-negative chronic hepatitis b (chb). methods a total of 665 chb patients who were admitted to ningbo no. 2 hospital during june 2002 and january 2010 were enrolled, in which 428 were hbeag-positive and 237 were hbeag-negative. hbv dna loads, live histological inflammation grades and fibrosis stages were compared between two groups. spss 1 1.5 was used for statistical analysis. for measurement data, t (for normal distribution) or mann-whitney u (for skew distribution) was performed; for enumeration data, chi-square test was performed; and pearson correlation analysis was conducted. results liver inflammatory grade and fibrosis staging in hbeag-negative chb patients were more severe than those in hbeag-positive patients (x2 = 7.92 and 10.35, p ＜ 0.01 ). the ratio of serum hbv dna levels ＜ 3, ≥3- ＜ 5 log10 copies/ml in hbeag-negative chb patients were significant higher than those in hbeag-positive patients (x2 = 105.16 and 36.92 ,p ＜0.01 ) ; and the ratio of hbv dna ≥7 log10 copies/ml in hbeag-negative group was lower than that in hbeag-positive group (x2 = 110.18, p ＜0.01 ). with the rising of serum hbv dna levels, liver inflammatory grade and fibrosis staging in hbeag-positive patients had a descending tendency (r =-0.287 and-0.224, p ＜0.01 ), while those in the hbeag-negative group were ascending (r = 0.360 and 0.303, p ＜ 0.01 ). conclusion compared with hbeag-positive chb patients, liver inflammation and tissue damage in hbeag-negative patients are more severe, which need close monitoring.