Chronic HBV infection is a dynamic process that reflects the interaction between HBV replication and host immune response [6]. Identifying the different stages of the natural history of chronic HBV infection is crucial for determining prognosis and guiding treatment [5, 17]. However, recent studies have shown that a large proportion of individuals with chronic HBV infection cannot be classified into any specific phase based on their immune status and are considered to be in the “Grey Zone” of chronic HBV infection [10, 18]. Different guidelines have varying HBV DNA and ALT thresholds, leading to inconsistent criteria for GZ. The prognosis for GZ patients is also inconsistent, and there is still no consensus on their treatment [19]. Antiviral therapy is primarily guided by serum HBV DNA levels, serum ALT levels,…