<h4>Objective</h4>To analyze the clinical and hepatic pathological characteristics of patients with chronic hepatitis B (CHB) alone or with non-alcoholic fatty liver disease (NAFLD), who have normal alanine aminotransferase (ALT) levels.<h4>Methods</h4>The patients with normal ALT levels and pathologically diagnosed CHB alone or in combination with NAFLD were enrolled, the demographic, laboratory, and pathological data were collected and analyzed.<h4>Results</h4>Among 391 enrolled CHB patients with normal ALT levels, 107 individuals combined with NAFLD. The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.