Study On The Relationship Between The Severity Of Acute Pancreatitis And TCM Syndromes By Three Scoring Systems

Object: To evaluate the value of harmless acute pancreatitis score(HAPS),beside index of severity in acute pancreatitis(BISAP),and acute physiology and chronic health evaluation II(APACHE-?)scores in predicting the severity of acute pancreatitis.Exploring the distribution of TCM syndrome types of acute pancreatitis,and exploring the relationship between TCM syndrome types and severity based on the distribution of HAPS,BISAP and APACHE-? scores,providing a basis for Chinese medicine to judge the severity of acute pancreatitis and guide treatment.Methods: Retrospectively collect data on 890 inpatients from West China Hospital of Sichuan University from January 2016 to August 2017 who were older than 18 years and had an onset time of less than 48 hours.Scored BISAP,HAPS,APACHE-? for all patients at admission.Patients were categorized into mild acute pancreatitis(MAP),moderately severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP)according to severity.To evaluate the value of HAPS predicting non-SAP,and BISAP,APACHE-? scores predicting the value of SAP.Cases from October 2016 to August 2017 were selected to analyze the distribution of different TCM syndrome types.To compare the distribution of HAPS,BISAP,and APACHE-? scores in different syndrome types,to compare the severity of different types of syndromes.Results: The HAPS scores of MAP,MSAP,and SAP groups were 1.89±0.69,1.77±0.71,1.36±0.68,respectively,the BISAP scores were 0.59±0.57,0.91±0.79,1.84±0.88,respectively,and the APACHE-? scores were 3.56±2.29,4.19±2.33,7.90±4.02,respectively.The scores of the three scoring systems in different severity groups were statistically significant(P<0.05),and the higher the severity,the lower the HAPS score,but the higher the BISAP and APACHE-? scores.The specificity,sensitivity,positive predictive value,and negative predictive value of the HAPS score for predicting non-severe acute pancreatitis were 95%,18%,95%,and 18%,respectively,and the area under the receiver's operating characteristic curve(AUC)was 0.673(95% confidence interval: 0.626-0.721).The optimal cutoff values of SAP and APACHE-? scores for SAP were 1.5 and 5.5,respectively,and AUC was 0.809 and 0.811,respectively.There was no statistically significant difference between AUC(P>0.05).Among the TCM syndromes of acute pancreatitis,the sputum heat combined blood stasis syndrome were the most(55.5%),followed by the phlegm heat syndrome(39.7%),and the proportion of liver and gallbladder damp-heat syndrome and liver qi stagnation syndrome was very small.The number of cases of phlegm heat syndrome,phlegm heat combined blood stasis syndrome,liver and gallbladder damp-heat syndrome,and liver qi stagnation syndrome in the MAP group were 126,82,4,and 4,respectively,but in the MSAP group were 70,149,5,and 3,respectively,and in the SAP group were 13,61,1,and 0,respectively.The distribution of different syndrome types in different severity groups was different(P<0.05).The MAP group was mainly composed of phlegm and heat syndrome(the ratio was 57.8%),but the MSAP group and SAP group were mainly sputum heat combined blood stasis syndrome(the ratio were 64.8% and 80.3%,respectively).The HAPS scores of phlegm heat syndrome,phlegm heat combined blood stasis syndrome,liver and gallbladder damp-heat syndrome,and liver qi stagnation syndrome were 1.83±0.68,1.72±0.71,1.78±0.67,1.83±0.41,respectively,and the BISAP score was 0.74±0.75,1.07±0.88,0.44±0.52,0.33±0.52,respectively,the APACHE-? scores were 4.26±2.84,4.83±3.30,2.78±1.99,3.67±1.63,respectively.The HAPS score of sputum heat combined blood stasis syndrome was lower than that of sputum heat syndrome,but the BISAP and APACHE-? scores were higher.Meanwhile the BISAP and APACHE-? scores of sputum heat combined blood stasis syndrome were higher than liver and gallbladder damp-heat syndrome,and the APACHE-? score of sputum heat combined blood stasis syndrome was higher than that of liver qi stagnation syndrome,the difference was statistically significant(P<0.05).Conclusion: HAPS,BISAP,and APACHE-? scores can predict the severity of acute pancreatitis early,but HAPS and BISAP scores are more introductory and economical,which suitable for clinical promotion.The TCM syndrome type of acute pancreatitis is mainly composed of sputum heat combined blood stasis syndrome and phlegm heat syndrome.The severity of sputum heat combined blood stasis syndrome was the highest.Chinese medicine treatment of acute pancreatitis should be based on Tongli,clearing away heat and detoxification,moderate to severe patients should also strengthen blood circulation.