急性重症胰腺炎中医证型分布与病情转归的关系分析

Relationship between distribution of traditional Chinese medicine syndrome types and outcomes of patients with acute severe pancreatitis

目的分析急性重症胰腺炎中医证型分布,探讨其与病情转归的关系。方法回顾性分析河南中医药大学第一附属医院2018年5月至2023年4月收治的107例急性重症胰腺炎患者的临床资料,统计患者中医证型分布和入院14 d病情转归情况。统计学方法采用t检验、χ^(2)检验,多因素分析采用Cox回归分析模型。结果107例急性重症胰腺炎患者中医证型占比从高到低依次为腑实热结证[39.25%(42/107)]、肝胆湿热证[30.84%(33/107)]、瘀毒互结证[18.69%(20/107)]、内闭外脱证[10.28%(11/107)]、肝郁气滞证[0.93%(1/107)];不同证型病因分布比较,差异有统计学意义(χ^(2)=64.08,P<0.05);急性重症胰腺炎患者病情加重发生率为19.63%(21/107),多因素Cox回归分析结果显示,瘀毒互结证[风险比(HR)=5.307,95%置信区间(CI)1.394~20.201,P=0.014]、内闭外脱证(HR=7.941,95%CI 2.204~28.614,P=0.001)、入院时急性生理学和慢性健康状况评分Ⅱ(HR=1.384,95%CI 0.732~2.617,P=0.008)、入院时兰森(Ranson)评分(HR=1.639,95%CI 1.165~2.305,P=0.005)是急性重症胰腺炎病情加重的危险因素。结论急性重症胰腺炎患者中医证型以腑实热结证为主,瘀毒互结证、内闭外脱证是急性重症胰腺炎患者病情转归的影响因素。

Objective To analyze the distribution of traditional Chinese medicine syndrome types in acute severe pancreatitis,and to explore the relationship between traditional Chinese medicine syndrome types and disease outcomes.Methods A retrospective analysis was conducted on the clinical data of 107 patients with acute severe pancreatitis admitted to First Hospital,Henan University of Chinese Medicine from May 2018 to April 2023.The distribution of traditional Chinese medicine syndrome types and their prognosis 14 days after admission were statistically analyzed.χ^(2) and t tests were used.The Cox regression analysis model was used for the multivariate analysis.Results The proportion of the traditional Chinese medicine syndrome types in the 107 patients from high to low were visceral excess heat syndrome(39.25%,42/107),liver and gallbladder dampness heat syndrome(30.84%,33/107),stasis and toxin combined syndrome(18.69%,20/107),internal closure and external detachment syndrome(10.28%,11/107),and liver depression and qi stagnation syndrome(0.93%,1/107).There were no statistical differences in gender and age distributions between the patients of different syndrome types(both P>0.05),while there was a statistical difference in the distribution of causes between the patients of different syndrome types(χ^(2)=64.08,P<0.001).The incidence of exacerbation in the patients with severe acute pancreatitis was 19.63%(21/107).The results of multivariate Cox regression analysis showed that stasis and toxin combined syndrome[risk ratio(HR)=5.307,95%confidence interval(95%CI)1.394-20.2015,P=0.014],internal closure and external detachment syndrome(HR=7.941,95%CI 2.204-28.614,P=0.001),acute physiology and chronic health evaluationⅡscore at admission(HR=1.384,95%CI 0.732-2.617,P=0.008),and Ranson score at admission(HR=1.639,95%CI 1.165-2.305,P=0.005)were risk factors for the exacerbation of the patients with acute severe pancreatitis.Conclusions The main traditional Chinese medicine syndrome of patients with acute severe pancreatitis is visceral excess heat syndrome;stasis and toxin combined syndrome and internal closure and external detachment syndrome are the influencing factors for their prognosis.