Abstract: Objective To explore the correlation between serum hepatitis B core antibody (HBcAb) level and hepatic tissue pathological staging in patients with chronic hepatitis B (CHB). Methods A total of 436 CHB patients who had undergone hepatic biopsy were collected from our hospital. The HBsAg, HBeAg/HBeAb, HBcAb and HBV DNA level were measured using I2000 and M2000 of Abbott. Correlation between serum HBcAb and degree of fibrosis was assessed statistically. Results As the severity of liver fibrosis increased, the HBcAb level gradually increased, and the differences were significant between the groups (F=4.664, P=0.003). Logistic regression analysis showed that the level of HBcAb was an independent prognostic factor of moderate to severe liver fibrosis, with fibroscan score, ALT, AST, HBsAg and HBV DNA level (P<0.05). Multiple logistic regression analysis showed that HBcAb, fibroscan score, HBsAg and HBV DNA level was correlated with moderate to severe liver fibrosis (P<0.05). ROC analysis suggested that a serum HBcAb cutoff of 10 (S/CO) would provide a theoretical sensitivity of 72.9% and with theoretical specificity of 52.63% in HBeAg (+) CHB patients, and the AUC is 0.72. Conclusion HBcAb levels increase gradually along with aggravation of liver fibrosis (S2-S4). The cutoff values of 10 (S/CO) for HBcAb predicts the degree of liver fibrosis in HBeAg-positive CHB patients, and is worthy of clinical application.