HBV carriers are divided into chronic HBV carriers and inactive HBsAg carriers. The traditional belief is that hepatitis B carriers do not need treatment. However, in actual clinical practice, many people who were HBV carriers in the past, once they develop the disease, a large proportion of them are already in the advanced stage of cirrhosis, because although HBV carriers show normal liver function and no obvious conscious discomfort, some of them actually still have liver histopathological changes, and some of them also have serious pathological changes. Therefore, proper monitoring of HBV carriers is necessary to detect lesions in a timely manner. The lesion activity of HBV carriers is often related to the following factors: mode of infection, duration of infection, alcohol consumption, whether other diseases are combined, long-term use of liver-damaging drugs, etc. Regular liver function tests are the most basic means of monitoring the disease, but other factors that can cause elevated transaminases need to be excluded, as well as auxiliary blood tests, ultrasound, AFP, etc. Liver tissue biopsy is the most accurate and objective means of disease monitoring. Combining the latest research data at home and abroad and the author’s experience, liver puncture biopsy should be performed in the following cases for further diagnosis and treatment: adults infected in infancy, those who have been infected for more than 20 years, those who drink alcohol regularly, those whose liver function test ALT is often in the high end of the normal range, those with positive serum HBVDNA, those with large spleen on ultrasound, those with a mild decrease in white blood cell count or platelet count on routine blood tests, and those with repeated liver tests. Those with mildly reduced blood count or platelet count, those with repeatedly elevated glutamyl transpeptidase or globulin or total bile acids on liver function tests.