ObjectiveTo investigate the clinical features of patients with acute exacerbation of chronic hepatitis B, and to provide a basis of evidence-based medicine for the diagnosis and treatment of acute exacerbation of chronic hepatitis B. MethodsA retrospective analysis was performed for the clinical data of 74 patients with acute exacerbation of chronic hepatitis B who were diagnosed in The People′s Hospital of Haikou from January 2011 to October 2015. These patients were divided into HBeAg positive group (51 patients) and HBeAg negative group (23 patients). The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe patients with acute onset of chronic hepatitis B had a level of alanine aminotransferase (ALT) of 523-2940 U/L and were manifested as icteric hepatitis (64 patients, 86.49%), and 65 patients (87.84%) were cured within 4 weeks. There were no significant differences in baseline ALT, aspartate aminotransferase, and HBV DNA levels between the HBeAg positive group and the HBeAg negative group (all P＞0.05), and the HBeAg negative group had a significantly higher level of total bilirubin (TBil) than the HBeAg positive group (141.1±132.9 μmol/L vs 80.1±68.8μmol/L, t=2.745, P=0.007). ConclusionThe acute exacerbation of chronic hepatitis B is similar to acute hepatitis B, and the patients with negative HBeAg have a high level of TBil and severe hepatocyte injury.