Collaborative diagnosis and treatment strategy of Chinese and Western medicine for acute pancreatitis based on immune response_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Min ¹ , WU Pengyu ² , DENG Gao ¹ , XI Heng ³ , LI Jiazhen ⁴ ,  WEN Jun ⁵

1. Department of Traditional Chinese Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
2. Department of Gastroenterology, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
3. Department of Pharmacy, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
4. Department of Nutrition, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
5. Section for Hepato-Pancreato-Biliary Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;

Corresponding?author：

WEN Jun, Email: junwen369@163.com

Keywords：

acute pancreatitis; immune response; intergrated traditional Chinese and Western medicine

DOI：

10.7507/1007-9424.202402008

Video：

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Abstract Full text Figures/Tables Video References Cited by

Acute pancreatitis is a common and critical disease in clinical practice, and clinical treatment has formed a multidisciplinary and collaborative model of traditional Chinese and Western medicine. However, its etiology and pathogenesis are complex and varied, and immune response is crucial in the occurrence and development of the disease. Therefore, based on the thinking of the pathological and physiological basis of immune response in the different stages of acute pancreatitis disease progression and related complications, and based on the biological characteristics and laws of the disease, this article summarizes a reasonable and phased implementation of Chinese and Western medicine collaborative management strategy, which is proposed to achieve optimal and precise treatment of the disease.

Citation： CHEN Min, WU Pengyu, DENG Gao, XI Heng, LI Jiazhen, WEN Jun. Collaborative diagnosis and treatment strategy of Chinese and Western medicine for acute pancreatitis based on immune response. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 155-160. doi: 10.7507/1007-9424.202402008 Copy

1.	Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology, 2013, 144(6): 1252-1261.
2.	Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol, 2019, 16(8): 479-496.
3.	Sharma D, Jakkampudi A, Reddy R, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: preliminary results of an ongoing study. Dig Dis Sci, 2017, 62(12): 3468-3478.
4.	徐喆, 柴潤東, 趙舒武, 等. 中西醫結合診療模式思路探討. 天津中醫藥大學學報, 2022, 41(5): 563-566.
5.	中國醫師協會胰腺病學專業委員會. 中國急性胰腺炎多學科診治 (MDT) 共識意見 (草案). 中國實用內科雜志, 2015, 35(12): 1004-1010.
6.	Merza M, Hartman H, Rahman M, et al. Neutrophil extracellular traps induce trypsin activation, inflammation, and tissue damage in mice with severe acute pancreatitis. Gastroenterology, 2015, 149(7): 1920-1931.
7.	de-Madaria E, Herrera-Marante I, González-Camacho V, et al. Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: a triple-blind, randomized, controlled trial. United European Gastroenterol J, 2018, 6(1): 63-72.
8.	Maléth J, Hegyi P. Ca²⁺ toxicity and mitochondrial damage in acute pancreatitis: translational overview. Philos Trans R Soc Lond B Biol Sci, 2016, 371(1700): 20150425. doi: 10.1098/rstb.2015.0425.
9.	Babu BI, Finch JG. Current status in the multidisciplinary management of duodenal fistula. Surgeon, 2013, 11(3): 158-164.
10.	沈波, 虞洪, 郭豐, 等. 重癥急性胰腺炎合并醫源性十二指腸瘺的分析和微創治療. 中華醫學雜志, 2019, 99: 1418-1420.
11.	Whitcomb DC. Central role of the sentinel acute pancreatitis event (SAPE) model in understanding recurrent acute pancreatitis (RAP): implications for precision medicine. Front Pediatr, 2022, 10: 941852. doi: 10.3389/fped.2022.941852.
12.	Lepp?niemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
13.	Albers D, Meining A, Hann A, et al. Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: early intervention does not compromise outcome. Endosc Int Open, 2021, 9(3): E490-E495.
14.	van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
15.	高堃, 童智慧, 李維勤. 胰腺壞死組織感染的影像學特征、微創介入方式及時機. 中國實用外科雜志, 2019, 39(6): 575-580.
16.	Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med, 2014, 371(21): 1983-1993.
17.	段建華. 早期腸內營養和腸外營養在治療重癥急性胰腺炎中的療效對比研究. 中華危重癥醫學雜志(電子版), 2012, 5(2): 82-86.
18.	Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA, 2021, 325(4): 382-390.
19.	Yang AL. Nutrition and acute pancreatitis. J Clin Med, 2021, 10(4): 836. doi: 10.3390/jcm10040836.
20.	Gomes CA, Di Saverio S, Sartelli M, et al. Severe acute pancreatitis: eight fundamental steps revised according to the ‘PANCREAS’ acronym. Ann R Coll Surg Engl, 2020, 102(8): 555-559.
21.	Ramanathan M, Aadam AA. Nutrition management in acute pancreatitis. Nutr Clin Pract, 2019, 34 Suppl 1: S7-S12.
22.	Kozie? D, G?uszek S. Epidemiology of acute pancreatitis in Poland– selected problems. Medical Studies/Studia Medyczne, 2016, 32(1): 1-3. doi:10.5114/ms.2016.58798.
23.	Murphy AE, Codner PA. Acute pancreatitis: exploring nutrition implications. Nutr Clin Pract, 2020, 35(5): 807-817.
24.	Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis. Br J Surg, 2000, 87(6): 695-707.
25.	Arvanitakis M, Ockenga J, Bezmarevic M, et al. ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr, 2024, 43(2): 395-412.
26.	Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology, 2018, 154(4): 1096-1101.
27.	金濤, 黃偉, 張瀟穎, 等. 急性胰腺炎中西醫結合診療指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
28.	余瑩, 程健. 重癥急性胰腺炎“腑氣不通”的中醫病機本質探討. 中國療養醫學, 2023, 32(1): 32-36.
29.	易志忠, 陳國忠, 袁鐵超, 等. 大承氣湯治療重癥急性胰腺炎臨床療效的Meta分析. 中國中醫急癥, 2020, 29(8): 1370-1373.
30.	Zhu F, Yin S, Zhu X, et al. Acupuncture for relieving abdominal pain and distension in acute pancreatitis: a systematic review and meta-analysis. Front Psychiatry, 2021, 12: 786401. doi: 10.3389/fpsyt.2021.786401.
31.	Zhang K, Gao C, Li C, et al. Acupuncture for acute pancreatitis: a systematic review and meta-analysis. Pancreas, 2019, 48(9): 1136-1147.
32.	孫備, 李冠群. 創傷遞升式分階段治療感染性胰腺壞死再認識. 中國實用外科雜志, 2021, 41(4): 374-378.
33.	van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
34.	Ocampo C, Zandalazini H, Alonso F, et al. A multimodal approach for the first-line treatment of infected pancreatic necrosis. Pancreas, 2020, 49(6): 757-762.
35.	Castellanos G, Pi?ero A, Doig LA, et al. Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience. Surg Endosc, 2013, 27(2): 443-453.
36.	董元航, 姜春暉, 郭威, 等. 鼻胃鏡和常規胃鏡在經皮內鏡胰腺壞死組織清除術中的應用對比研究. 中華消化內鏡雜志, 2019, 36(11): 815-820.
37.	曹鋒, 李昂, 高崇崇, 等. 感染性胰腺壞死分區與腹腔鏡手術入路選擇臨床研究. 中國實用外科雜志, 2020, 40(4): 457-460, 464.
38.	隋宇航, 孫備. 感染性胰腺壞死分型的初探與外科干預策略的再思考. 中華外科雜志, 2021, 59(7): 601-607.
39.	中國中西醫結合學會普通外科專業委員會. 重癥急性胰腺炎中西醫結合診治指南(2014年, 天津). 中國中西醫結合外科雜志, 2014(4): 460-464.
40.	李慧, 陳國忠, 唐曦平, 等. 從“氣血津液-絡病-肺濁”探討重癥急性胰腺炎肺損傷的動態演變. 吉林中醫藥, 2023, 43(8): 890-893.
41.	鄭俊全. 血府逐瘀口服液聯合生長抑素治療急性胰腺炎的臨床研究. 現代藥物與臨床, 2014, 29(8): 907-910.
42.	高世平, 劉濤, 張玲等. 桃核承氣湯聯合早期多部位穿刺置管引流治療重癥急性胰腺炎的臨床研究. 世界中西醫結合雜志, 2018, 13(8): 1132-1135, 1139.
43.	祝濤, 鈕宏文. 自擬消炎湯輔助經皮穿刺置管引流術治療急性胰腺炎合并胰腺周圍組織壞死感染的療效觀察. 中國中醫急癥, 2020, 29(7): 1247-1249.
44.	Kahl S, Schütte K, Glasbrenner B, et al. The effect of oral pancreatic enzyme supplementation on the course and outcome of acute pancreatitis: a randomized, double-blind parallel-group study. JOP, 2014, 15(2): 165-174.
45.	Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency-breaking the myths. BMC Med, 2017, 15(1): 29. doi: 10.1186/s12916-017-0783-y.
46.	杜燁湘, 羅敏, 馮敏, 等. 甘草素通過抗炎發揮對阿爾茨海默病的保護作用. 免疫學雜志, 2019, 35(4): 327-333.
47.	李月陽, 雷根平, 董盛, 等. 柴胡的現代藥理作用研究進展. 海南醫學院學報, 2022, 28(22): 1748-1754.
48.	孔令青. “中西醫協同”是中西醫結合研究的一項重要內容. 中西醫結合研究, 2016, 8(2): 104-106.

1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology, 2013, 144(6): 1252-1261.
2. Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol, 2019, 16(8): 479-496.
3. Sharma D, Jakkampudi A, Reddy R, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: preliminary results of an ongoing study. Dig Dis Sci, 2017, 62(12): 3468-3478.
4. 徐喆, 柴潤東, 趙舒武, 等. 中西醫結合診療模式思路探討. 天津中醫藥大學學報, 2022, 41(5): 563-566.
5. 中國醫師協會胰腺病學專業委員會. 中國急性胰腺炎多學科診治 (MDT) 共識意見 (草案). 中國實用內科雜志, 2015, 35(12): 1004-1010.
6. Merza M, Hartman H, Rahman M, et al. Neutrophil extracellular traps induce trypsin activation, inflammation, and tissue damage in mice with severe acute pancreatitis. Gastroenterology, 2015, 149(7): 1920-1931.
7. de-Madaria E, Herrera-Marante I, González-Camacho V, et al. Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: a triple-blind, randomized, controlled trial. United European Gastroenterol J, 2018, 6(1): 63-72.
8. Maléth J, Hegyi P. Ca²⁺ toxicity and mitochondrial damage in acute pancreatitis: translational overview. Philos Trans R Soc Lond B Biol Sci, 2016, 371(1700): 20150425. doi: 10.1098/rstb.2015.0425.
9. Babu BI, Finch JG. Current status in the multidisciplinary management of duodenal fistula. Surgeon, 2013, 11(3): 158-164.
10. 沈波, 虞洪, 郭豐, 等. 重癥急性胰腺炎合并醫源性十二指腸瘺的分析和微創治療. 中華醫學雜志, 2019, 99: 1418-1420.
11. Whitcomb DC. Central role of the sentinel acute pancreatitis event (SAPE) model in understanding recurrent acute pancreatitis (RAP): implications for precision medicine. Front Pediatr, 2022, 10: 941852. doi: 10.3389/fped.2022.941852.
12. Lepp?niemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
13. Albers D, Meining A, Hann A, et al. Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: early intervention does not compromise outcome. Endosc Int Open, 2021, 9(3): E490-E495.
14. van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
15. 高堃, 童智慧, 李維勤. 胰腺壞死組織感染的影像學特征、微創介入方式及時機. 中國實用外科雜志, 2019, 39(6): 575-580.
16. Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med, 2014, 371(21): 1983-1993.
17. 段建華. 早期腸內營養和腸外營養在治療重癥急性胰腺炎中的療效對比研究. 中華危重癥醫學雜志(電子版), 2012, 5(2): 82-86.
18. Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA, 2021, 325(4): 382-390.
19. Yang AL. Nutrition and acute pancreatitis. J Clin Med, 2021, 10(4): 836. doi: 10.3390/jcm10040836.
20. Gomes CA, Di Saverio S, Sartelli M, et al. Severe acute pancreatitis: eight fundamental steps revised according to the ‘PANCREAS’ acronym. Ann R Coll Surg Engl, 2020, 102(8): 555-559.
21. Ramanathan M, Aadam AA. Nutrition management in acute pancreatitis. Nutr Clin Pract, 2019, 34 Suppl 1: S7-S12.
22. Kozie? D, G?uszek S. Epidemiology of acute pancreatitis in Poland– selected problems. Medical Studies/Studia Medyczne, 2016, 32(1): 1-3. doi:10.5114/ms.2016.58798.
23. Murphy AE, Codner PA. Acute pancreatitis: exploring nutrition implications. Nutr Clin Pract, 2020, 35(5): 807-817.
24. Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis. Br J Surg, 2000, 87(6): 695-707.
25. Arvanitakis M, Ockenga J, Bezmarevic M, et al. ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr, 2024, 43(2): 395-412.
26. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology, 2018, 154(4): 1096-1101.
27. 金濤, 黃偉, 張瀟穎, 等. 急性胰腺炎中西醫結合診療指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
28. 余瑩, 程健. 重癥急性胰腺炎“腑氣不通”的中醫病機本質探討. 中國療養醫學, 2023, 32(1): 32-36.
29. 易志忠, 陳國忠, 袁鐵超, 等. 大承氣湯治療重癥急性胰腺炎臨床療效的Meta分析. 中國中醫急癥, 2020, 29(8): 1370-1373.
30. Zhu F, Yin S, Zhu X, et al. Acupuncture for relieving abdominal pain and distension in acute pancreatitis: a systematic review and meta-analysis. Front Psychiatry, 2021, 12: 786401. doi: 10.3389/fpsyt.2021.786401.
31. Zhang K, Gao C, Li C, et al. Acupuncture for acute pancreatitis: a systematic review and meta-analysis. Pancreas, 2019, 48(9): 1136-1147.
32. 孫備, 李冠群. 創傷遞升式分階段治療感染性胰腺壞死再認識. 中國實用外科雜志, 2021, 41(4): 374-378.
33. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
34. Ocampo C, Zandalazini H, Alonso F, et al. A multimodal approach for the first-line treatment of infected pancreatic necrosis. Pancreas, 2020, 49(6): 757-762.
35. Castellanos G, Pi?ero A, Doig LA, et al. Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience. Surg Endosc, 2013, 27(2): 443-453.
36. 董元航, 姜春暉, 郭威, 等. 鼻胃鏡和常規胃鏡在經皮內鏡胰腺壞死組織清除術中的應用對比研究. 中華消化內鏡雜志, 2019, 36(11): 815-820.
37. 曹鋒, 李昂, 高崇崇, 等. 感染性胰腺壞死分區與腹腔鏡手術入路選擇臨床研究. 中國實用外科雜志, 2020, 40(4): 457-460, 464.
38. 隋宇航, 孫備. 感染性胰腺壞死分型的初探與外科干預策略的再思考. 中華外科雜志, 2021, 59(7): 601-607.
39. 中國中西醫結合學會普通外科專業委員會. 重癥急性胰腺炎中西醫結合診治指南(2014年, 天津). 中國中西醫結合外科雜志, 2014(4): 460-464.
40. 李慧, 陳國忠, 唐曦平, 等. 從“氣血津液-絡病-肺濁”探討重癥急性胰腺炎肺損傷的動態演變. 吉林中醫藥, 2023, 43(8): 890-893.
41. 鄭俊全. 血府逐瘀口服液聯合生長抑素治療急性胰腺炎的臨床研究. 現代藥物與臨床, 2014, 29(8): 907-910.
42. 高世平, 劉濤, 張玲等. 桃核承氣湯聯合早期多部位穿刺置管引流治療重癥急性胰腺炎的臨床研究. 世界中西醫結合雜志, 2018, 13(8): 1132-1135, 1139.
43. 祝濤, 鈕宏文. 自擬消炎湯輔助經皮穿刺置管引流術治療急性胰腺炎合并胰腺周圍組織壞死感染的療效觀察. 中國中醫急癥, 2020, 29(7): 1247-1249.
44. Kahl S, Schütte K, Glasbrenner B, et al. The effect of oral pancreatic enzyme supplementation on the course and outcome of acute pancreatitis: a randomized, double-blind parallel-group study. JOP, 2014, 15(2): 165-174.
45. Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency-breaking the myths. BMC Med, 2017, 15(1): 29. doi: 10.1186/s12916-017-0783-y.
46. 杜燁湘, 羅敏, 馮敏, 等. 甘草素通過抗炎發揮對阿爾茨海默病的保護作用. 免疫學雜志, 2019, 35(4): 327-333.
47. 李月陽, 雷根平, 董盛, 等. 柴胡的現代藥理作用研究進展. 海南醫學院學報, 2022, 28(22): 1748-1754.
48. 孔令青. “中西醫協同”是中西醫結合研究的一項重要內容. 中西醫結合研究, 2016, 8(2): 104-106.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Collaborative diagnosis and treatment strategy of Chinese and Western medicine for acute pancreatitis based on immune response

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