Positive anti-smooth muscle antibodies are commonly seen in liver diseases such as autoimmune hepatitis or non-hepatic diseases such as diagnosis of autoimmune hepatitis requiring glucocorticoid and immunosuppressive therapy. Anti-smooth muscle antibodies can be seen in a variety of liver diseases and non-liver diseases, and anti-smooth muscle antibody positivity is important for the diagnosis of autoimmune hepatitis. In particular, high potency positivity has relatively high specificity for the diagnosis of autoimmune hepatitis. Autoimmune hepatitis can only be diagnosed on the basis of anti-smooth muscle antibody and other autoimmune hepatitis antibodies, liver biopsy pathology, and exclusion of other causes of hepatitis. If autoimmune hepatitis is diagnosed, treatment with glucocorticoids such as prednisone tablets and immunosuppressants such as azathioprine should be prescribed. If the anti-smooth muscle antibody is positive, it is necessary to consult the rheumatology and immunology department in time and follow the doctor’s instructions to standardize the diagnosis and treatment.