With the rapid development of society and excessive utilization , river ecosystem has been deteriorated seriously, charaterizing by decreasing water resources, water pollution, decling biodiversity and shrinking wetlands, etc, which limit the sustainable development of social economy and the further improvement of people's quality of life. Assessment of river health is the foundation of ecosystem monitoring and protection, and has been paid great attention in China. Most researches of river health was a comprehensive assessment consisting of hydrology, water quality, river habitat, organism and so on, which assumed as a stationary river system. Fewer researches regard river vulnerability as an important part of river health assessment. Under the dual pressures from climate change and human activities, the ability of watersheds to recover from external disturbances is particularly important, and should be considered in the river health assessment. Located in the central part of the Shandong Province, the Xiaoqing River is an important area of politics, economy, technology and culture in this province, and plays a pivotal role in the development of the society and economy. Assessing the health status of the Xiaoqing River under the changing environment is essential for the sustainable development, especially since the resumption of navigation.A total of eight sites, located in the main stream of the Xiaoqing River, were evaluated in this paper. The river health assessment system of the main stream of the Xiaoqing River was constructed including 17 indices from 6 criterion layers to assess the health status, including water quantity, water quality, organisms, aquatic ecology, social services and watershed vulnerability. Four components, namely, precipitation change, climate changes, water use changes and the impervious area changes, were used to evaluate the watershed vulnerability caused by climate change and human disturbance. Monthly flow was obtained from 《HYDROLOGICAL DATA OF HUAIHE RIVER BASIN》, precipitation, temperature and land use data were downloaded from Resource and Environment Science and Data Center of Chinese academy of science, other data such as water quality were obtained by sampling in situ. Five indices were consisted in the vulnerability criterion layer, and the temperature and precipitation in 2030 were predicted by Weather generators, the area of impervious area in 2030 was by PLUS model, and the water use in 2030 was by traditional model plates in SPSS. The Analytic Hierarchy Process was applied to calculate the weight of the indicators, which the water quantity and water quality were conferred the heaviest value. Finally, the river health index of each site were calculated by the weight and the assigned value, and the river health level was divided into five levels, showing as very healthy state, healthy state, sub-healthy state, unhealthy state, inferior state.The results show that the weight of the indices ranged from 0.014 to 0.161, among which the weight of ecological flow and water purification were the largest, and the weight of the vulnerability of future temperature change in the future was the smallest. The main stream of Xiaoqing River is in sub-healthy state, and the river health index at 8 evaluation sites was distributed between 61.82 and 69.73. There was little difference among each site in the main stream, of which Huangtaiqiao is the highest and the Chahe site was the lowest. The water quantity scored the highest in the criterion layer. Poor aquatic biology and higher vulnerability facing the changing environment were the main limitation factors in the Xiaoqing River, and leading to unreliable health in the future. Besides, the river habitats layer and water quality layer scored ranked third and fourth, respectively. Spatial variation in this river showed a trend of lower scores from upstream to downstream. The ecological flow satisfaction scored the highest in the indicator layer, with a score of 100 for all 8 sites, and a score of 0 for the indicators of the changes in minimum temperature and future water use change. Stability of the riverbank and the changes of impervious area got higher score than other indicators. The vulnerability layer showed that the changes of temperature in next 10 years should be noted and measurements of alleviating the increase of temperature shoule be carried out. Water use scored 0, which may increase the intense of water in the future, and the policy of water conservation must be taken. River restoration work should be carried out in accordance with local conditions in response to the vulnerability factors in different river sections.The index system of the main stream in the Xiaoqing River can evaluate the health status comprehensively from 6 aspects, including water quantity, water quality, water aquatic species, water ecology, social services and vulnerability. Generally speaking, the above results showed that more efforts should be made to protect and restore the basin and prevent it from deterioration. In the future,we should not only strengthen the monitoring and governance of indices with low scores but also stabilize indicators with high scores to maintain the high health level. The construction of the evaluation index system in the Xiaoqing River provides a reference for scientific management, and may provide a theoretical support for the future ecological restoration and high-level development.