Objective To analyze the prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B. Methods The clinical data of patients with chronic hepatitis B who were hospitalized at the Department of Infectious Diseases,the First People's Hospital of Shunde,Guangdong,China,from January 2006 to December 2014,were retrospectively collected for analysis and comparison of clinical and pathological indicators. The patients were divided into fatty liver group and non- fatty liver group depending on the presence or absence of fatty liver. Continuous data of the two groups were compared using the t test and categorical data were compared using the χ2test. If data were not normally distributed,comparisons were made using the Mann- Whitney U test. Results The incidence of fatty liver increased with age( P < 0. 05) and peaked at an age of ≥45 years in both groups. Fatty liver was more likely to occur in men than in women below 30 years and between 30 and 44 years( P < 0. 05). Diabetes,abnormal levels of cholesterol,triglycerides,low- density lipoprotein,and uric acid,and a history of alcohol consumption were significantly more frequent in the fatty liver group than in the non- fatty liver group( P < 0.05). Levels of body mass index,gamma- glutamyl transpeptidase,albumin,blood urea nitrogen,creatinine,uric acid,glucose,total cholesterol,triglycerides,low- density lipoprotein,apolipoprotein A,apolipoprotein B,aspartate aminotransferase were significantly different between the two groups( P < 0. 05). Inflammation and fibrosis were significantly milder in the fatty liver group compared with the non- fatty liver group( P < 0. 05). Patients in the non- fatty liver group were more likely to be complicated by grade 3 liver inflammation and stage 3fibrosis( P = 0. 001 and P = 0. 015). Conclusion Fatty liver patients are more likely to present with glucose and lipid metabolism disorder. Hepatic steatosis is not significantly correlated with HBe Ag,but may be somewhat associated with HBV DNA,inflammation grade and fibrosis stage. Further studies are needed to establish their connections..