To observe the clinical effect of five ester capsules for refractory ALT elevation in patients with chronic hepatitis B.Methods：Divided 160 cases of chronic hepatitis B patients with refractory ALT elevation randomly into the observation group with 90 cases，the control group with 50 cases and the placebo group with 20 cases.The observation group was treated with five ester capsules；the control group was given drug therapy with diammonium glycyrrhizinate capsules；and the placebo group was additionally given placebo.All the three groups received routine antiviral treatment in hospital at the same time for three months.Observed and compared the clinical effect，normalization rate，rebound rate and ALT changes in the three groups.Results：The total effective rate was 88.89%in the observation group，75.00%in the placebo group and 68.00%in the control group；the total effective rate in the observation group was higher than that in the placebo group and the control group(P ＜ 0.05)，and the efficacy in the placebo group was equivalent to that in the control group(P＞0.05).The normalization rate of ALT in the observation group was 91.11%，being higher than that of 80.00%in the placebo group and 72.00%in the control group，difference being significant(P＜0.05).There was no significant difference being found in normalization rate of ALT between the placebo group and the control group(P＞0.05).The rebound rate of ALT in the observation group was 18.29%，being lower than that of 25.00%in the placebo group and 33.33%in the control group，difference being significant(P ＜ 0.05)；there was no significant difference being found in rebound rate of ALT between the placebo group and the control group(P ＞ 0.05).After treatment，ALT values in the three groups were decreased significantly when compared with those before treatment(P ＜ 0.05).However，no significant differences were found in the comparison between any two groups among the three groups(P＞0.05).Conclusion：The application of five ester capsules can effectively reduce serum ALT values and has good effect in the treatment for refractory ALT elevation in patients with chronic hepatitis B.