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Difficulties and prospects of combined traditional Chinese and Western medicine in the treatment of severe acute pancreatitis

Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.

Clinical Analysis of 9 Cases of Obese Type Ⅱ Diabetes and Ketoacidosis Combined with Acute Pancreatitis

目的:提高臨床醫師對以腹痛為首發癥狀的肥胖型2型糖尿病酮癥酸中毒（DKA）并高脂血癥（HL）性急性胰腺炎（AP）的認識。方法:回顧性分析我院2005年1月至2008年3月收治的9例肥胖型2型糖尿病酮癥酸中毒并高脂血癥性急性胰腺炎患者的臨床資料。結果:（1）9例均為青年男性，年齡30.78±5.56歲；（2）病前均無糖尿病史及相關癥狀，均無高脂血癥史；（3）病前均無暴飲、暴食和膽石癥史；（4）均以腹痛為首發癥狀，均有腹壓痛；（5）均為肥胖體型，體質指數28.33±1.54 kg/m2；（6）均達到DKA診斷標準；（7）入院時有7例血淀粉酶升高，其中6例超過正常值3倍以上，2例正常（其中1例入院后升高達正常值3倍以上）；（8）入院時均有高脂血癥，其中3例脂血，6例TG均gt;113 mmol/L，DKA糾正后（入院后第3天）TG降至1.1～1.8 mmol/L，TC降至3.6～4.6 mmol/L；（9）B超或CT均有胰腺炎改變；（10）治愈后癥狀解除，血TG、TC均正常或稍高，血尿淀粉酶均正常。結論:（1）以腹痛就診的DKA患者，應常規查TG、TC、血尿淀粉酶、胰腺B超或CT，以排除高脂血癥性胰腺炎；（2）青年肥胖型2型糖尿病可能以糖尿病酮癥酸中毒并高脂血癥性急性胰腺炎為首發表現入院。

Nutritional Supart in Patients with Severe Acute Pancreatitis

急性胰腺炎的CT診斷

目的 探討CT對急性胰腺炎的診斷價值。 方法 回顧性分析2007年3月-2009年10月收治的35例急性胰腺炎患者的CT照片。 結果 35例患者中CT診斷為急性水腫型胰腺炎26例(74.3%)，急性壞死型胰腺炎9例(25.7%)。CT主要表現胰腺體積增大31例，其中胰頭增大10例，胰體、尾單獨或同時增大21例，4例胰腺表現基本正常。單側或雙側腎前筋膜水腫增厚27例(77.1%)， 胰腺邊緣模糊、部分脂肪層消失20例(57.1%)，膽囊增大膽總管擴張17例(48.6%)，胰周蜂窩組織炎6例(17.1%)，合并左側胸腔積液5例(14.3%)，伴有少量腹水2例(5.7%)。 結論 CT檢查可以顯示胰腺自身腫大、壞死、出血，還能夠顯示胰外的腹腔、腹膜后腔以及腎筋膜的受累情況，可為臨床制定合理的治療方案并作出預后的判斷提供依據。

Prevention and Therapy of Complications with Acute Pancreatitis

Change of Blood Glucose and Its Clinical Significance in the Patients with Acute Pancreatitis

ObjectiveTo investigate the change of blood glucose and its clinical significance in patients with acute pancreatitis (AP). MethodsThe regularity of blood glucose change and the relation between the regularity and the prognosis were analyzed in 115 patients with AP and hyperglycemia.ResultsBlood glucose was increased with a median (M) of 8.7 mmol/L，18.45 mmol/L and 27.22 mmol/L, which gradually decreased to normal value within 3-17 days, 7-26 days and 24-46 days after treatment,respectively in patients with mild AP, type Ⅰ of severe acute pancreatitis (SAP) and type Ⅱ of SAP. There was marked statistical difference among the three groups. A smaller dose of regular insulin was used for 36 patients with mild AP; however, a larger dose of regular insulin was used for all 30 patients with SAP.ConclusionThe level of blood glucose, the dose of regular insulin and the duration of hyperglycemia increase with the severity of AP.

Mechanism of Liver Capillary Permeability in Rats with Severe Acute Pancreatitis

ObjectiveTo explore the mechanism of liver capillary permeability in rats with severe acute pancreatitis (SAP). MethodsTotally 40 healthy Sprague-Dawley (SD) rats were randomly divided into two groups: sham operation (SO) group and SAP group, SAP group were divided into four subgroups according to sampling time (3 h， 6 h, 12 h， and 24 h). The model was established by injecting 5% sodium taurocholate retrogradely into pancreaticobiliary ducts. The changes of tumor necrosis factor-α (TNF-α), pathohistology, and tissue moisture content were compared among different groups. Liver occludin protein expression was analyzed by immunohistochemistry method, and occludin mRNA was measured by RT-PCR. ResultsThere was no significant pathological changes of liver tissue in the SO group. Typical pathological changes of SAP， such as interstitial edema, vasodilatation, infiltration of inflammatory cells, were found in the SAP group. TNF-α level and tissue moisture content of each phase increased gradually, and the highest level appeared at 24 h within the observing period. The two above indicators at different time point in subgroups were significantly different from each other and higher than those in the SO group (Plt;0.05)． In the SAP group, the expression of occludin and it’s mRNA began to decrease at 3 h to the bottom at 6 h and rebounced significantly at 12 h, 24 h compared with those at 6 h (Plt;0.05), but still lower than those in the SO group (Plt;0.05). ConclusionUpregulation in TNF-α and subsequent downregulation in occludin protein and mRNA maybe bly related to the severe liver capillary permeability in rats with SAP.

Effect of Urokinase on Severity Acute Pancreatitis with Renal Injury in Rat

Objective　To explore the effect of renal microcirculation following severity acute pancreatitis （SAP） on renal injury and to explore the protection effect of urokinase on them. Methods　A total of 192 Wistar rats were randomized divided into normal control group， SAP group， and urokinase group， then rats of 3 groups were sub-divided into 2， 6， 12， and 24 hours group， each group enrolled 16 rats. Of the 16 rats in each subgroup， 8 rats underwent blood flow of renal test， other 8 rats were sacrificed to get blood samples and to perform histopathological examination. The rat models of SAP were established by retrograde injecting with 5% sodium taurocholate into the cholangiopancreatic duct. Radioactive biomicrosphere technique was used to measure the blood flow of renal， levels of plasma thromboxane B2（TXB2） and 6-keto-prostaglandin F1α （6-Keto-PGF1α） were tested by the TXB2 kit and 6-Keto-PGF1α kit， and histopa-thological changes of renal tissues were observed by using HE staining. Results　Compared with normal control group at the same time point， the blood flow of renal were lower （P＜0.05）， activity ratio of TXB2 to 6-Keto-PGF1α were higher（P＜0.01）， and the histopathological injury were worse （P＜0.01） in rats of SAP group and urokinase group. Compared with SAP group， the blood flow of renal at 2， 6， and 12 hours in urokinase group were higher （P＜0.01）， the activity ratios of TXB2 to 6-Keto-PGF1α were lower （P＜0.01）， and the histopathological injury were lighter （P＜0.05） in all the 4 time points of urokinase group. Conclusions　The renal microcirculation dysfunction and increase of activity ratio of TXB2 to 6-Keto-PGF1α may play an important role in renal injury following SAP in early stage. Urokinase can protect the renal from such injuries.

Role of chaiqin chengqi decoction on serum lipid metabolism in experimental acute pancreatitis

Objective To investigate the effect of chaiqin chengqi decoction (CQCQD) on serum lipid metabolism in experimental acute pancreatitis. Methods A total of 27 C57BL/6 mice were randomly divided into three groups (n=9 for each group). The mice in the acute pancreatitis model group (AP group) and the acute pancreatitis model + CQCQD treatment group (APQ group) received seven intraperitoneal injections of cerulein (50 μg/kg) at hourly intervals, while the mice in the control group (CON group) received phosphate-buffered saline injections at the same regimen of cerulein. Oral gavage of CQCQD (5.5 g/kg) or same volume of distilled water was commenced 1 h after the first cerulein injection for three times at intervals of 4 h for the APQ group and AP group, respectively. Animals were sacrificed 12 h after the first cerulein / phosphate-buffered saline injection for collecting serum and tissue samples. The levels of serum lipase and amylase, pancreatic histopathology assessment, as well as pancreatic myeloperoxidase activity, were used to assess the severity of acute pancreatitis and the efficacy of CQCQD. Additionally, serum lipid metabolites were analyzed in all groups. Results In comparison to the CON group, the mice in the AP group exhibited significant edema, inflammatory cell infiltration, necrosis of pancreatic tissues, as well as elevated levels of serum amylase, lipase, and pancreatic myeloperoxidase activity (P<0.05); in comparison to the AP group, inflammatory cell infiltration and necrosis of pancreatic tissue, as well as elevated level of serum amylase significantly reduced in the APQ group (P<0.05). A total of 319 lipid molecules were identified in serum, and 13 lipid metabolites were significantly increased in the AP group and successfully decreased in the APQ group, of which 9 were lyso-phosphatidylethanolamine (LPE) molecules involved in the glycerol phospholipid metabolic pathway. Further statistical analysis revealed that six of these LPE molecules could serve as potential biomarkers. Conclusions CQCQD ameliorated pancreatic injury and serum lipid metabolism disorder of acute pancreatitis model induced by cerulein and significantly improved the abnormal increase of serum LPE level. However, the role of LPE in acute pancreatitis and the underlying mechanisms of CQCQD on LPE metabolic pathways still need further study.

The effects of early enteral nutrition therapy combined with micro-ecological preparation on intestinal function recovery in patients with severe acute pancreatitis

Objective To explore the effects of early enteral nutrition therapy combined with micro-ecologicalpreparation on early intestinal function recovery in patients with severe acute pancreatitis (SAP). Methods The clinical data of 48 patients with SAP treated from January 2012 to January 2015 were retrospectively analyzed. Out of the 48 cases, 23 were treated with early enteral nutrition therapy (the control group), and 25 were treated with early enteral nutrition therapy combined with micro-ecologicalpreparation (the observation group). The counts of white blood cells (WBC), the levels of blood amylase, serum lipase, lactic dehydrogenase (LDH), and the scores of gastrointestinal function 1 day before treatment and on the 7th and 14th day of treatment were observed. The incidences of complications, case fatality rates, and lengths of hospital stay were recorded. Results One day before treatment, the differences in the counts of WBC, the levels of blood amylase, lipase, and LDH between the two groups were not statistically significant (P>0.05). On the 7th day of treatment, the counts of WBC, the levels of blood amylase, lipase, and LDH in the two groups decreased in varying degrees, and the decreasing in the observation group was more obvious (P<0.05). On the 14th day of treatment, the levels of blood amylase in the two groups were almost normal, and the difference between the two groups was not statistically significant (P>0.05); the levels of lipase, LDH and the counts of WBC in the observation group were lower than those in the control group (P<0.05). One day before treatment, the difference in the scores of gastrointestinal function between the control group (1.34±0.76) and the observation group (1.46±0.62) was not statistically significant (P>0.05); on the 7th and 14th day of treatment, the scores of gastrointestinal function in the observation group (0.37±0.18, 0.29±0.06) were lower than those in the control group (0.63±0.32, 0.47±0.08), and the differences were statistically significant (P<0.05). There were significant differences between the two groups in terms of the incidence of total complications and length of hospital stay (P<0.05), while the difference in the case fatality rate between the two groups was not statistically significant (P>0.05). Conclusion Early enteral nutrition combined with micro-ecological preparation is benefit to the intestinal function recovery in patients with SAP.