Network analysis of core symptoms and symptom clusters in patients with severe acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Shushu ,  ZHANG Ru

Department of General Surgery ICU, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Provincial People’s Hospital), Nanjing 210029, P. R. China;

Corresponding?author：

ZHANG Ru, Email: ruzhang1075@163.com

Keywords：

acute pancreatitis; network analysis; symptom cluster; core symptom; nursing care

DOI：

10.7507/1007-9424.202603143

Video：

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Objective To explore the incidence and severity of diverse clinical symptoms in patients with severe acute pancreatitis (SAP), construct a symptom correlation network model, accurately identify core symptoms within the network, and classify symptom clusters. Methods A convenience sampling method was adopted. A total of 211 patients with SAP admitted to the First Affiliated Hospital with Nanjing Medical University (Jiangsu Provincial People’s Hospital) from January 2024 to December 2025 were enrolled. The memorial symptom assessment scale was used for evaluation to investigate the composition of clinical symptoms in SAP patients. Exploratory factor analysis was performed to extract symptom clusters. R 4.4.2 software was applied to construct symptom clusters network. Centrality indicators including strength, betweenness and closeness were analyzed to identify core symptoms and core symptom clusters. Results A total of three symptom clusters were extracted in this study, including the gastrointestinal symptom cluster (abdominal pain, abdominal distension, dyspnea, dry mouth, nausea, vomiting, diarrhea, constipation, dizziness), the fatigue symptom cluster (lack of energy, difficulty concentrating, drowsiness), and the psychological symptom cluster (anxiety, sleep disturbance, irritability, sadness, distress). Among them, anxiety [95.7% (202/211)], difficulty concentrating [94.8% (200/211)], lack of energy [92.4% (195/211)], and abdominal pain [90.0% (190/211)] were identified as core symptoms. Symptoms with high strength values included anxiety (r_s=2.2), difficulty concentrating (r_s=1.2), and dyspnea (r_s=1.0); symptoms with high closeness centrality values included drowsiness (r_c=1.8), difficulty concentrating (r_c=1.7), and anxiety (r_c=1.1); symptoms with high betweenness centrality values included difficulty concentrating (r_b=2.3), anxiety (r_b=2.0), and drowsiness (r_b=1.5). Conclusions Anxiety, difficulty concentrating, lack of energy, and abdominal pain were identified as the core symptoms within the symptom clusters of SAP patients, with the fatigue symptom cluster being the core symptom cluster. It is recommended that medical staff pay close attention to the manifestations of core symptoms in SAP patients during treatment and formulate targeted symptom management plans.

Citation： WANG Shushu, ZHANG Ru. Network analysis of core symptoms and symptom clusters in patients with severe acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1079-1083. doi: 10.7507/1007-9424.202603143 Copy

1.	楊文聰, 王雪婷. 奧美拉唑聯合烏司他丁及免疫腸內營養治療重癥急性胰腺炎的臨床療效 [J]. 中國藥物與臨床, 2025, 25(20): 1339-1344.
2.	Qian J, Wang XH, Wei BZ, et al. Therapeutic effects of salidroside vs pyrrolidine dithiocarbamate against severe acute pancreatitis in rat [J]. J Tradit Chin Med, 2022, 42(1): 49-57.
3.	Beij A, Verdonk RC, van Santvoort HC, et al. Acute pancreatitis: an update of evidence-based management and recent trends in treatment strategies [J]. United European Gastroenterol J, 2025, 13(1): 97-106.
4.	丁祥林, 陳鑫, 陳美玉, 等. 基于影像組學與3D深度學習的多模態模型在重癥急性胰腺炎預測中的應用 [J]. 臨床肝膽病雜志, 2025, 41(10): 2110-2117.
5.	Trikudanathan G, Yazici C, Evans Phillips A, et al. Diagnosis and management of acute pancreatitis [J]. Gastroenterology, 2024, 167(4): 673-688.
6.	張琦, 佟明銘, 陶紅, 等. 胰炎消方治療重癥急性胰腺炎療效及對炎癥因子、肝臟功能和腸黏膜屏障功能的影響 [J]. 中國中醫急癥, 2022, 31(1): 122-125.
7.	姬宇瀟, 姚偉龍, 李鵬, 等. 急性胰腺炎鎮痛管理現狀 [J]. 胃腸病學和肝病學雜志, 2023, 32(1): 1-4.
8.	尚紅良, 李剛, 劉媛媛, 等. 286例急性胰腺炎患者癥狀群發展軌跡影響因素及預防建議 [J]. 公共衛生與預防醫學, 2025, 36(5): 154-158.
9.	劉賀冰. 急性胰腺炎患者癥狀群發展軌跡及其影響因素研究 [D]. 吉林: 吉林大學, 2024.
10.	皋林, 童智慧. 基于循證依據的急性胰腺炎營養干預治療進展 [J]. 醫學研究與戰創傷救治, 2023, 36(7): 697-700.
11.	溫曉萌, 孫彩萍, 韓小云, 等. 食管癌患者核心癥狀及癥狀群的網絡分析 [J]. 護理學雜志, 2025, 40(5): 20-25.
12.	Zhou K, Huang X, Chen M, et al. Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: a cross-sectional study [J]. J Adv Nurs, 2024, 80(7): 2785-2800.
13.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus [J]. Gut, 2013, 62(1): 102-111.
14.	Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper [J]. Behav Res Methods, 2018, 50(1): 195-212.
15.	Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress [J]. Eur J Cancer, 1994, 30A(9): 1326-1336.
16.	Fu L, Hu Y, Lu Z, et al. Validation of the simplified Chinese version of the memorial symptom assessment scale-short form among cancer patients [J]. J Pain Symptom Manage, 2018, 56(1): 113-121.
17.	蔡玉清, 董書陽, 袁帥, 等. 變量間的網絡分析模型及其應用 [J]. 心理科學進展, 2020, 28(1): 178-190.
18.	段曉培, 程星遙. 焦慮癥患者的靜息態腦功能影像分析 [J]. 國際精神病學雜志, 2023, 50(1): 57-59.
19.	魏珂, 張文穩, 馮光, 等. 五行音樂干預對重癥監護病房撤機困難患者焦慮抑郁障礙和撤機成功率的影響 [J]. 中華危重病急救醫學, 2024, 36(10): 1044-1048.
20.	傅咪咪, 張龍, 褚亞芬. 通過互聯網平臺實施正念減壓聯合音樂療法干預對2型糖尿病伴焦慮患者的影響 [J]. 重慶醫學, 2024, 53(s1): 296-298.
21.	李軍, 魏國峰, 蔡兆輝, 等. 急性胰腺炎繼發器官功能衰竭患者凝血功能及外周血TIM-3 TAT ACE2水平變化分析 [J]. 河北醫學, 2024, 30(3): 436-441.
22.	王獻萍. 時間觀療法對急性白血病患者化療期間癥狀群的干預效果 [J]. 河北醫藥, 2025, 47(7): 1215-1219.
23.	吳詠姿, 韓晨霞, 蔡文浩, 等. 神經源性炎癥與急性胰腺炎疼痛 [J]. 中國普外基礎與臨床雜志, 2022, 29(9): 1165-1168.
24.	Ahmed A, Anand AN, Shah I, et al. Prospective evaluation of sleep disturbances in chronic pancreatitis and its impact on quality of life: a pilot study [J]. Sleep Breath, 2022, 26(4): 1683-1691.
25.	秦博, 馮全管, 韓小燕. 復方大柴胡湯治療急性胰腺炎肝膽濕熱證 [J]. 吉林中醫藥, 2025, 45(7): 815-818.
26.	Quan Y, Yang XJ. Metabolic syndrome and acute pancreatitis: current status and future prospects [J]. World J Gastroenterol, 2024, 30(45): 4859-4863.

1. 楊文聰, 王雪婷. 奧美拉唑聯合烏司他丁及免疫腸內營養治療重癥急性胰腺炎的臨床療效 [J]. 中國藥物與臨床, 2025, 25(20): 1339-1344.
2. Qian J, Wang XH, Wei BZ, et al. Therapeutic effects of salidroside vs pyrrolidine dithiocarbamate against severe acute pancreatitis in rat [J]. J Tradit Chin Med, 2022, 42(1): 49-57.
3. Beij A, Verdonk RC, van Santvoort HC, et al. Acute pancreatitis: an update of evidence-based management and recent trends in treatment strategies [J]. United European Gastroenterol J, 2025, 13(1): 97-106.
4. 丁祥林, 陳鑫, 陳美玉, 等. 基于影像組學與3D深度學習的多模態模型在重癥急性胰腺炎預測中的應用 [J]. 臨床肝膽病雜志, 2025, 41(10): 2110-2117.
5. Trikudanathan G, Yazici C, Evans Phillips A, et al. Diagnosis and management of acute pancreatitis [J]. Gastroenterology, 2024, 167(4): 673-688.
6. 張琦, 佟明銘, 陶紅, 等. 胰炎消方治療重癥急性胰腺炎療效及對炎癥因子、肝臟功能和腸黏膜屏障功能的影響 [J]. 中國中醫急癥, 2022, 31(1): 122-125.
7. 姬宇瀟, 姚偉龍, 李鵬, 等. 急性胰腺炎鎮痛管理現狀 [J]. 胃腸病學和肝病學雜志, 2023, 32(1): 1-4.
8. 尚紅良, 李剛, 劉媛媛, 等. 286例急性胰腺炎患者癥狀群發展軌跡影響因素及預防建議 [J]. 公共衛生與預防醫學, 2025, 36(5): 154-158.
9. 劉賀冰. 急性胰腺炎患者癥狀群發展軌跡及其影響因素研究 [D]. 吉林: 吉林大學, 2024.
10. 皋林, 童智慧. 基于循證依據的急性胰腺炎營養干預治療進展 [J]. 醫學研究與戰創傷救治, 2023, 36(7): 697-700.
11. 溫曉萌, 孫彩萍, 韓小云, 等. 食管癌患者核心癥狀及癥狀群的網絡分析 [J]. 護理學雜志, 2025, 40(5): 20-25.
12. Zhou K, Huang X, Chen M, et al. Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: a cross-sectional study [J]. J Adv Nurs, 2024, 80(7): 2785-2800.
13. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus [J]. Gut, 2013, 62(1): 102-111.
14. Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper [J]. Behav Res Methods, 2018, 50(1): 195-212.
15. Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress [J]. Eur J Cancer, 1994, 30A(9): 1326-1336.
16. Fu L, Hu Y, Lu Z, et al. Validation of the simplified Chinese version of the memorial symptom assessment scale-short form among cancer patients [J]. J Pain Symptom Manage, 2018, 56(1): 113-121.
17. 蔡玉清, 董書陽, 袁帥, 等. 變量間的網絡分析模型及其應用 [J]. 心理科學進展, 2020, 28(1): 178-190.
18. 段曉培, 程星遙. 焦慮癥患者的靜息態腦功能影像分析 [J]. 國際精神病學雜志, 2023, 50(1): 57-59.
19. 魏珂, 張文穩, 馮光, 等. 五行音樂干預對重癥監護病房撤機困難患者焦慮抑郁障礙和撤機成功率的影響 [J]. 中華危重病急救醫學, 2024, 36(10): 1044-1048.
20. 傅咪咪, 張龍, 褚亞芬. 通過互聯網平臺實施正念減壓聯合音樂療法干預對2型糖尿病伴焦慮患者的影響 [J]. 重慶醫學, 2024, 53(s1): 296-298.
21. 李軍, 魏國峰, 蔡兆輝, 等. 急性胰腺炎繼發器官功能衰竭患者凝血功能及外周血TIM-3 TAT ACE2水平變化分析 [J]. 河北醫學, 2024, 30(3): 436-441.
22. 王獻萍. 時間觀療法對急性白血病患者化療期間癥狀群的干預效果 [J]. 河北醫藥, 2025, 47(7): 1215-1219.
23. 吳詠姿, 韓晨霞, 蔡文浩, 等. 神經源性炎癥與急性胰腺炎疼痛 [J]. 中國普外基礎與臨床雜志, 2022, 29(9): 1165-1168.
24. Ahmed A, Anand AN, Shah I, et al. Prospective evaluation of sleep disturbances in chronic pancreatitis and its impact on quality of life: a pilot study [J]. Sleep Breath, 2022, 26(4): 1683-1691.
25. 秦博, 馮全管, 韓小燕. 復方大柴胡湯治療急性胰腺炎肝膽濕熱證 [J]. 吉林中醫藥, 2025, 45(7): 815-818.
26. Quan Y, Yang XJ. Metabolic syndrome and acute pancreatitis: current status and future prospects [J]. World J Gastroenterol, 2024, 30(45): 4859-4863.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Network analysis of core symptoms and symptom clusters in patients with severe acute pancreatitis

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