Preliminary Study On The Characteristics Of Damp Syndrome And Its Quantitative Diagnostic Criteria In Patients With Pancreatic Cancer

Damp syndrome is formed by a series of pathological changes caused by exogenous dampness or abnormal fluid transport in the body,and it is an important component of pancreatic cancer syndrome.Damp is Yin pathogen and easy to change into heat,which always cause deseases internal and external of the body;Patients with damp syndrome have different symptoms and signs under different diseases,so it is difficult to judge it by single diagnostic criteria.At present,there is no relevant research on the diagnostic criteria of pancreatic cancer damp syndrome.In view of the above problems,This study attempts to explore the characteristics of damp syndrome in patients with pancreatic cancer and to preliminarily establish a quantitative diagnostic criteria of damp syndrome based on pancreatic cancer disease.Objective:To observe the characteristics of damp syndrome in pancreatic cancer patient and establish a related quantitative diagnostic criteria.Method:1.Summarize the symptoms and signs of the damp syndrome appearing in the authoritative books of Traditional Chinese Medicine and related diagnostic criteria,form a pool of candidate items for dampness syndrome diagnosis and formulate a clinical case observation table.2.Collecting 133 patients with clinically diagnosed pancreatic cancer,fill out the case observation form,according to the diagnostic criteria of Traditional Chinese Medicine divide 133 patients with pancreatic cancer into two groups:damp syndrome and non-damp syndrome.3.Using EpiData 3.1 for information input,using SPSS 23.0 and Excel to analyse data.Using Chi square test and rank sum test to analyze the differences in gender,age,primary lesion,clinical stage,metastatic site,presence or absence of ascites,treatment methods(including surgical treatment,chemotherapy,radiation therapy)and CA199 levels in patients with damp syndrome and non-damp syndrome group.4.Calculate the frequency of candidate diagnostic items appearing in the two groups,remove the low frequency items of damp sydrome group,using chi-square test to find out if there are statistical differences between the two groups,calculate the OR value to finally determine the diagnostic items of pancreatic cancer damp syndrome.Conditional probability method was used to assign the diagnostic items,diagnostic threshold was established using maximum likelihood methods and the grading standards were established using percentile methods.5.Retrospectively test the diagnostic criteria of pancreatic cancer damp syndrome established by the study,calculate the sensitivity[a/(a+c)],specificity[d/(b+d)],accuracy[a+d/a+b+c+d],positive likelihood ratio[a(a+c)/b/(b+d)],negative likelihood ratio[c/(a+c)/d/(b+d)]of the standard,to test the diagnostic value of the proposed standard.Result:A total of 133 patients with pancreatic cancer were enrolled in the study,including 73 patients with damp syndrome,accounting for 54.9%of the total number of patients,and 60 patients with non-damp syndrome,accounting for 45.1%of the total number of patients.1.Characteristics of damp syndrome in patient with pancreatic cancerIn terms of general condition,63 of the 133 patients were male,accounting for 47.4%of the total;70 were female,accounting for 52.6%of the total,the proportion of male in the damp syndrome group(50.7%)was higher than that of the non-damp syndrome group(43.3%),but there was no statistical difference in gender distribution between two groups.The average age of the total sample was(61.05±10.21)years old.The average age of damp syndrome group(62.00±9.41)was higher than that of non-damp one(59.90± 11.08),but there were no statistical difference between two groups.In terms of tumor condition,the frequency of pancreatic neck(8.2%),pancreatic tail(15.1%)and pancreatic body and tail cancer(20.5%)in damp syndrome group was higher than that in non-damp one(3.3%,10.0%,16.7%)and the frequency of pancreatic body cancer in non-damp syndrome group(16.7%)was higher than that in damp Syndrome(8.2%)group,but there was no statistical difference between the two groups;In terms of distant metastasis sites,the proportion of liver(34.3%)and lung(11.0%)metastasis in the damp syndrome group was significantly higher than that in the non-damp syndrome group(25.0%,3.3%),but there was no statistical difference.On the distribution of ascites and staging of tumor,damp syndrome and non-damp syndrome group had similar frequency,and had no statistical difference.In terms of treatment,The proportion of patients without operation in the damp syndrome group(52.1%)was significantly higher than that in the non-damp one(35.0%),but with no statistical difference;There was no significant difference and no statistical significance in the proportion of radiotherapy and whether having chemical therapy within 3 months between the two groups.As for the distribution of CA199 level,the proportion of normal CA199 patients in damp syndrome group(31.5%)was significantly lower than that in non-damp one(41.7%).The proportion of CA199 which belong to 40?400U/ml category patients in non-damp syndrome group(16.7%)was significantly lower than that in damp one(31.5%),but there was no statistical difference in the distribution of CA199 level between the two groups.2.Preliminary formulation of quantification and classification diagnostic criteria for pancreatic cancer damp syndromeUsing statistical analysis,we build the quantification and classification diagnostic criteria of damp syndrome for pancreatic cancer as follows:weighted body(7),yellow sclera or skin(10)?heavy head(8)?cutaneous pruritus(6)?sticky mouth(5)?cloudy urine(12)?sticky stool(6)?slippery pulse(8)?greasy coated tongue(5)?ventosity(4)?tastelessness(10)?thirsty and drink little(8)?piss poor(6)?swollen tongue(5)?sore waist(3).The diagnostic threshold of damp syndrome was 23 points,23 points to 28 points were divided into mild damp syndrome,28 points to 36 points were divided into moderate damp syndrome,36 points or above were severe damp syndrome.The results of the retrospective examination of the established criteria showed that the sensitivity,specificity,accuracy,positive likelihood ratio and negative likelihood ratio were 66.7%,87.0%,76.0%,5.11 and 0.38 respectively.It shows that the established quantitative standard had a realatively high diagnostic value.Conclusion:1.There were no significant differences in gender,age,primary lesion,clinical stage,metastatic site,presence or absence of ascites,treatment method and CA199 level in patients with pancreatic cancer damp syndrome and non-damp syndrome.2.The quantitative diagnostic criteria for pancreatic cancer damp syndrome established in this study have a high diagnostic value by retrospective test which can be used for clinical syndrome differentiation and efficacy evaluation.