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目的:评估终末期肝病模型联合血清钠评分（MELD-Na）、慢性肝衰竭-序贯器官衰竭评估模型简化评分（CLIF-C OFs）、中国重型乙型肝炎（乙肝）研究组乙肝相关的慢加急性肝衰竭预后评分（COSSH-ACLFs）、中性粒细胞/淋巴细胞比值（NLR）评分系统在乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者中的应用价值。方法:回顾性收集2010年7月至2018年7月天津市第二人民医院收治的163例HBV-ACLF患者的临床资料（性别、年龄、疾病分期）以及实验室检查指标〔丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBil）、白蛋白（ALB）、血尿素氮（BUN）、肌酐（Cr）、血钠（Na）、凝血酶原活动度（PTA）、国际标准化比值（INR）、中性粒细胞计数（NEU）、淋巴细胞计数（LYM）〕，以入院8周为观察时间节点，根据预后不同将患者分为存活组（90例）和死亡组（73例）。比较死亡组和存活组的MELD-Na、CLIF-C OFs、COSSH-ACLFs评分及NLR差异，并行Logistic回归分析，确定HBV-ACLF的独立危险因素。行倾向匹配分析，验证独立危险因素的准确性，绘制受试者工作特征曲线（ROC），判断独立危险因素的临床价值。结果:存活组和死亡组患者入院时性别、疾病分期、ALB、BUN、Cr、Na、NEU水平比较差异均无统计学意义（均n P>0.05）；存活组年龄、ALT、AST、TBil、INR水平均明显低于死亡组〔年龄（岁）：43.00（34.00，53.00）比50.00（42.50，55.00），ALT（U/L）：252.90（61.43，613.33）比359.10（115.15，784.70），AST（U/L）：146.15（90.88，449.30）比237.80（109.00，635.05），TBil（μmol/L）：265.10（183.10，347.60）比307.50（229.90，405.55），INR：2.13（1.91，2.46）比2.29（2.02，2.94）〕，PTA和LYM水平均明显高于死亡组〔PTA（%）：34.00（28.00，38.00）比31.00（24.00，36.00），LYM（×10n 9/L）：1.37（0.72，1.79）比0.85（0.51，1.39），均n P<0.05〕；与死亡组比较，存活组MELD-Na、CLIF-C OFs、COSSH-ACLFs评分及NLR均更低〔MELD-Na评分（分）：17.99（16.60，19.63）比19.16（17.43，20.80），CLIF-C OFs评分（分）：9.00（8.00，9.00）比9.00（9.00，10.00），COSSH-ACLFs评分（分）：4.87（4.63，5.48）比5.47（5.07，5.80），NLR：2.86（2.21，5.19）比4.38（2.54，8.46），均n P<0.05〕。Logistic回归分析显示，CLIF-C OFs评分〔优势比（n OR）＝0.532，95%可信区间（95%n CI）为0.380～0.744，n P<0.05〕、NLR（n OR＝0.901，95%n CI为0.835～0.972，n P0.05），入院基线资料中仅LYM间比较差异具有统计学意义〔×10n 9/L：1.35（0.74，1.73）比0.81（0.51，1.30），n P<0.05〕；存活组的CLIF-C OFs、COSSH-ACLFs评分及NLR均明显低于死亡组〔CLIF-C OFs评分（分）：9.00（8.00，9.00）比9.00（8.00，10.00），COSSH-ACLFs评分（分）：4.99（4.69，5.64）比5.34（5.03，5.81），NLR：2.85（2.21，5.72）比4.38（2.47，10.20），均n P<0.05〕；CLIF-C OFs评分（n OR＝0.593，95%n CI为0.401～0.878，n P<0.05）、NLR（n OR＝0.914，95%n CI为0.842～0.993，n P 0.05). The age [years old: 43.00 (34.00, 53.00) vs. 50.00 (42.50, 55.00)] and serum levels of ALT [U/L: 252.90 (61.43, 613.33) vs. 359.10 (115.15, 784.70)], AST [U/L: 146.15 (90.88, 449.30) vs. 237.80 (109.00, 635.05)], TBil [μmol/L: 265.10 (183.10, 347.60) vs. 307.50 (229.90, 405.55)] and INR [2.13 (1.91, 2.46) vs. 2.29 (2.02, 2.94)] in survival group were lower than those in death group and the PTA [%: 34.00 (28.00, 38.00) vs. 31.00 (24.00, 36.00)] and LYM [×10 n 9/L: 1.37 (0.72, 1.79) vs. 0.85 (0.51, 1.39)] levels were significantly higher than those in death group (both n P < 0.05). The MELD-Na [17.99 (16.60, 19.63) vs. 19.16 (17.43, 20.80)], CLIF-C OFs [9.00 (8.00, 9.00) vs. 9.00 (9.00, 10.00)], COSSH-ACLFs [4.87 (4.63, 5.48) vs. 5.47 (5.07, 5.80)] and NLR [2.86 (2.21, 5.19) vs. 4.38 (2.54, 8.46)] were lower in survival group than those of the death group (all n P < 0.05). Logistic regression analysis showed that CLIF-C OFs [odds ratio ( n OR) = 0.532, 95% confidence interval (95%n CI) was 0.380-0.744, n P < 0.05] and NLR ( n OR = 0.901, 95%n CI was 0.835-0.972, n P 0.05), and statistically significant difference in the baseline LYM [×10 n 9/L: 1.35 (0.74, 1.73) vs. 0.81 (0.51, 1.30)] were found between the survival group and the death group. The CLIF-C OFs, COSSH-ACLFs scores and NLR were lower in survival group compared with those of the death group [CLIF-C OFs: 9.00 (8.00, 9.00) vs. 9.00 (8.00, 10.00), COSSH-ACLFs: 4.99 (4.69, 5.64) vs. 5.34 (5.03, 5.81), NLR: 2.85 (2.21, 5.72) vs. 4.38 (2.47, 10.20), all n P < 0.05] and CLIF-C OFs ( n OR = 0.593, 95%n CI was 0.401-0.878, n P < 0.05) and NLR ( n OR = 0.593, 95%n CI was 0.401-0.878, n P < 0.05) were still as the independent risk factors for the prognosis of HBV-ACLF. The sensitivity of CLIF-C OFs≥9 and NLR≥3.14 to forecast the 8-week clinical outcome of HBV-ACLF patients were 76.7% and 67.1%, the specificity were 48.9% and 56.7%, and AUC were 0.662 and 0.623. CLIF-C OFs was combined with NLR to increase the specificity of forecasting the 8-week clinical outcome of HBV-ACLF patients to 77.8%.n Conclusions:CLIF-C OFs and NLR scores are independent risk factors affecting the clinical outcome of HBV-ACLF, and have better clinical value in predicting the prognosis of HBV-ACLF. Combined application of the two scores will be more beneficial to the prognosis of HBV-ACLF.