目的 探索甲胎蛋白（AFP）和前白蛋白（PAB）水平与HBV相关慢加急性肝衰竭（HBV-ACLF）患者90 d预后的关系及不同AFP、PAB水平患者90 d预后差异。 方法 纳入2018年1月—2023年1月在中国人民解放军西部战区总医院住院治疗的HBV-ACLF患者371例，根据出院后90 d随访结果分为生存组（n=216）和死亡组（n=155）。通过病历系统收集患者一般资料及AFP和PAB等相关实验室指标。正态分布的计量资料两组间比较采用成组t检验；多组间比较采用单因素方差分析，进一步两两比较采用LSD-t检验。非正态分布的计量资料两组间比较采用Mann-Whitney U检验；多组间比较及进一步两两比较均采用Kruskal-Wallis H检验。计数资料组间比较采用χ²检验。采用多因素Logistic回归分析HBV-ACLF患者预后的影响因素。通过AFP和PAB的受试者操作特征曲线（ROC曲线），确定二者的截断值。应用Kaplan-Meier法绘制生存曲线，并采用Log-rank检验进行比较。 结果 生存组Hb、PAB、AFP和PLT水平均显著高于死亡组（P值均<0.05）；年龄、TBil、WBC、胱抑素、肌酐、尿素、国际标准化比值、MELD评分、Child-Pugh C级患者占比、2级腹水及肝性脑病的发生率均显著低于死亡组（P值均<0.05）。多因素Logistic回归分析显示，PAB（OR=0.985，95%CI：0.972～0.998，P=0.024）、AFP（OR=0.998，95%CI：0.996～1.000，P=0.028）、PLT（OR=0.989，95%CI：0.982～0.996，P=0.003）、年龄（OR=1.046，95%CI：1.018～1.075，P=0.001）、TBil（OR=1.004，95%CI：1.002～1.006，P<0.001）和WBC（OR=1.237，95%CI：1.110～1.379，P<0.001）是HBV-ACLF患者90 d预后的独立影响因素。根据AFP及PAB的ROC曲线截断值将患者分为A组102例（AFP≥73.19 ng/mL且PAB≥22.55 mg/L）、B组170例（AFP≥73.19 ng/mL且PAB<22.55 mg/L；AFP<73.19 ng/mL且PAB≥22.55 mg/L）和C组99例（AFP<73.19 ng/mL且PAB<22.55 mg/L）。3组间比较，年龄、Hb、国际标准化比值、MELD评分及Child-Pugh分级差异均有统计学意义（P值均<0.05）。生存曲线分析显示，A组患者90 d累积生存率显著高于B组和C组（χ²=19.825，P<0.001）。 结论 AFP联合PAB能较好地预测HBV-ACLF患者的90 d预后，其中高AFP及高PAB水平的患者90 d病死率更低。

Objective To investigate the association of alpha-fetoprotein （AFP） and prealbumin （PAB） with the 90-day prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF），as well as the difference in 90-day prognosis between the patients with different levels of AFP and PAB. Methods A total of 371 HBV-ACLF patients who were hospitalized in The General Hospital of Western Theater Command from January 2018 to January 2023 were enrolled，and according to the follow-up results on day 90 after discharge，they were divided into survival group with 216 patients and death group with 155 patients. The medical record system was used to collect general data，AFP，PAB，and other related laboratory markers. The t-test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups，and the least significant difference t-test was used for comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups，and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to identify the influencing factors for the prognosis of HBV-ACLF patients. The receiver operating characteristic （ROC） curve was plotted for AFP and PAB to determine their cut-off values. The Kaplan-Meier method was used to plot survival curves，and the Log-rank test was used for comparison. Results Compared with the death group，the survival group had significantly higher levels of hemoglobin （Hb），PAB，AFP，and platelet count （PLT）（all P<0.05） and significantly lower age，total bilirubin （TBil），white blood cell count （WBC），cystatin，creatinine，urea，international normalized ratio （INR），Model for End-Stage Liver Disease （MELD） score，proportion of patients with Child-Pugh class C，and incidence rates of ascites and hepatic encephalopathy （all P<0.05）. The multivariate logistic regression analysis showed that PAB （odds ratio ［OR］=0.985，95% confidence interval ［CI］：0.972‍ ‍—‍ ‍0.998，P=0.024），AFP （OR=0.998，95%CI：0.996‍ ‍—‍ ‍1.000，P=0.028），PLT （OR=0.989，95%CI：0.982‍ ‍—‍ ‍0.996，P=0.003），age （OR=1.046，95%CI：1.018‍ ‍—‍ ‍1.075，P=0.001），TBil （OR=1.004，95%CI：1.002‍ ‍—‍ ‍1.006，P<0.001），and WBC （OR=1.237，95%CI：1.110‍ ‍—‍ ‍1.379，P<0.001） were independent influencing factors for 90-day prognosis in HBV-ACLF patients. According to the cut-off values of AFP and PAB on ROC curves，the patients were divided into group A with 102 patients （AFP≥73.19 ng/mL and PAB≥22.55 mg/L），group B with 170 patients （AFP≥73.19 ng/mL and PAB<22.55 mg/L； AFP<73.19 ng/mL and PAB≥22.55 mg/L），and group C with 99 patients （AFP<73.19 ng/mL and PAB<22.55 mg/L）. There were significant differences between these three groups in age，Hb，INR，MELD score，and Child-Pugh class （all P<0.05）. The Kaplan-Meier survival analysis showed that group A had a significantly higher 90-day cumulative survival rate than groups B and C （χ²=19.825，P<0.001）. Conclusion AFP combined with PAB can better predict the 90-day prognosis of HBV-ACLF patients，and patients with high levels of AFP and PAB tend to have a lower mortality rate on day 90.