目的：探讨并发急性肾损伤（acute kidney injury，AKI）的慢加急性肝功能衰竭（acute-chronic liver failure， ACLF）患者血清集聚蛋白多糖 C 端片段（C-terminal agrin fragment，CAF）水平用于 AKI 诊断的价值。方法HBV 相关ACLF 患者347例，其中 AKI 患者165例，无 AKI 患者182例。记录患者一般信息及常规实验室指标，检测血清 CAF 水平。分析 CAF 与各项指标的相关性，ROC 曲线分析 CAF 用于 ACLF 患者 AKI 诊断的效能。结果AKI 组 CAF 水平[1243．3（678．4，2105．9）pg／mL]显著高于无-AKI 组[250．2（135．7，436．5）pg／mL]，差异有统计学意义（P ＜0．01）；不同AKI 分期 CAF 水平由高至低依次为：AKI-3期＞AKI-2期＞AKI-1期。AKI 组患者血清 CAF 水平与 MAP 呈显著负相关（R＝－0．242，P ＝0．004）、eGFR（R＝－0．480，P ＜0．01），与 ALT（R＝0．222，P ＝0．004）、WBC（R＝0．212，P ＝0．006）、sCr （R＝0．392，P ＜0．01）及 MELD 评分（R ＝0．272，P ＜0．01）。CAF 用于诊断 ACLF 并发 AKI 的 AUC 为0．859（95％CI ：0．819～0．898），而 CAF 联合 sCr 的 AUC 为0．923（95％CI ：0．894～0．951）。结论CAF 反映 ACLF 患者并发 AKI 时的肾功能损害严重程度，并可与 sCr 联合用于提高 AKI 的诊断效能。%Objective To investigate serum C-terminal agrin fragment (CAF)level and its clinical diagnostic value in acute kidney injury (AKI)patients with acute-on-chronic liver failure (ACLF).Methods A total of 347 patients with hepatitis B virus (HBV)related ACLF from April 2012 to February 2015 in our center were enrolled retrospectively,and then divided into AKI group (n = 165 )and non-AKI group (n = 182 ).The general information and routine laboratory parameters were recorded,and the serum CAF level was detected.The correlation between CAF and parameters was analyzed,and diagnostic efficiency of CAF for AKI in patients with ACLF was evaluated by receiver operating characteristic (ROC)curve.Results The level of CAF in AKI group (1243.3(678.4-436.5)pg/mL)was significantly higher than that in non-AKI group (250.2 (2105.9 ~ 135.7)pg/mL,P <0.001),and increased with different stage of AKI,in order from AKI-1 to AKI-2 to AKI-3.In addition,the CAF levels were significantly negatively correlated with mean arterial pressure (MAP)(R=-0.242,P =0.004)and glomerular filtration rate (R=-0.480,P <0.001),while positively correlated with alanine aminotransferase level (R=0.222,P =0.004),white blood cell count (R =0.212,P =0.006),serum creatinine (sCr)level (R=0.272,P <0.001)and model for end stage liver disease score (R =0.392,P <0.001 ).Area under the curve (AUC)of CAF used for the diagnosis of AKI in patients with ACLF was 0.859 (95%CI :0.819-0.898),and the AUC of CAF with sCr was 0.923 (95%CI :0.894-0.951 ).Conclusion CAF can reflect the severity of renal damage of AKI in patients with ACLF,and it can be combined with sCr to improve the diagnosis efficiency of AKI.
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