Lay summary
  1. Alterations in the levels of circulating metabolites specific to patients with chronic hepatitis B (CHB) exhibiting persistently elevated alanine aminotransferase (PeALT) levels were identified.
  2. ALT levels were most strongly negatively correlated with levels ofN -acetyl-l-methionine (NALM); Supplementation with NALM alleviated hepatocyte necrosis in a CCl4-induced mouse model of acute liver injury.
  3. The identified key differential metabolites may serve as potential biomarkers and/or therapeutic targets for PeALT in patients with CHB.