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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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, 柴润东, 赵舒武, 等. 中西医结合诊疗模式思路探讨. 天津中医药大学学报, 2022, 41(5): 563-566.
5.	中国医师协会胰腺病学专业委员会. 中国急性胰腺炎多学科诊治 (MDT) 共识意见 (草案). 中国实用内科杂志, 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, 郭丰, 等. 重症急性胰腺炎合并医源性十二指肠瘘的分析和微创治疗. 中华医学杂志, 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.	Leppäniemi 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, 李维勤. 胰腺坏死组织感染的影像学特征、微创介入方式及时机. 中国实用外科杂志, 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.	段建华. 早期肠内营养和肠外营养在治疗重症急性胰腺炎中的疗效对比研究. 中华危重症医学杂志(电子版), 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.	Kozieł D, Głuszek 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.	金涛, 黄伟, 张潇颖, 等. 急性胰腺炎中西医结合诊疗指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
28.	余莹, 程健. 重症急性胰腺炎“腑气不通”的中医病机本质探讨. 中国疗养医学, 2023, 32(1): 32-36.
29.	易志忠, 陈国忠, 袁铁超, 等. 大承气汤治疗重症急性胰腺炎临床疗效的Meta分析. 中国中医急症, 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.	孙备, 李冠群. 创伤递升式分阶段治疗感染性胰腺坏死再认识. 中国实用外科杂志, 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, Piñero 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, 姜春晖, 郭威, 等. 鼻胃镜和常规胃镜在经皮内镜胰腺坏死组织清除术中的应用对比研究. 中华消化内镜杂志, 2019, 36(11): 815-820.
37.	曹锋, 李昂, 高崇崇, 等. 感染性胰腺坏死分区与腹腔镜手术入路选择临床研究. 中国实用外科杂志, 2020, 40(4): 457-460, 464.
38.	隋宇航, 孙备. 感染性胰腺坏死分型的初探与外科干预策略的再思考. 中华外科杂志, 2021, 59(7): 601-607.
39.	中国中西医结合学会普通外科专业委员会. 重症急性胰腺炎中西医结合诊治指南(2014年, 天津). 中国中西医结合外科杂志, 2014(4): 460-464.
40.	李慧, 陈国忠, 唐曦平, 等. 从“气血津液-络病-肺浊”探讨重症急性胰腺炎肺损伤的动态演变. 吉林中医药, 2023, 43(8): 890-893.
41.	郑俊全. 血府逐瘀口服液联合生长抑素治疗急性胰腺炎的临床研究. 现代药物与临床, 2014, 29(8): 907-910.
42.	高世平, 刘涛, 张玲等. 桃核承气汤联合早期多部位穿刺置管引流治疗重症急性胰腺炎的临床研究. 世界中西医结合杂志, 2018, 13(8): 1132-1135, 1139.
43.	祝涛, 钮宏文. 自拟消炎汤辅助经皮穿刺置管引流术治疗急性胰腺炎合并胰腺周围组织坏死感染的疗效观察. 中国中医急症, 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.	杜烨湘, 罗敏, 冯敏, 等. 甘草素通过抗炎发挥对阿尔茨海默病的保护作用. 免疫学杂志, 2019, 35(4): 327-333.
47.	李月阳, 雷根平, 董盛, 等. 柴胡的现代药理作用研究进展. 海南医学院学报, 2022, 28(22): 1748-1754.
48.	孔令青. “中西医协同”是中西医结合研究的一项重要内容. 中西医结合研究, 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, 柴润东, 赵舒武, 等. 中西医结合诊疗模式思路探讨. 天津中医药大学学报, 2022, 41(5): 563-566.
5. 中国医师协会胰腺病学专业委员会. 中国急性胰腺炎多学科诊治 (MDT) 共识意见 (草案). 中国实用内科杂志, 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, 郭丰, 等. 重症急性胰腺炎合并医源性十二指肠瘘的分析和微创治疗. 中华医学杂志, 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. Leppäniemi 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, 李维勤. 胰腺坏死组织感染的影像学特征、微创介入方式及时机. 中国实用外科杂志, 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. 段建华. 早期肠内营养和肠外营养在治疗重症急性胰腺炎中的疗效对比研究. 中华危重症医学杂志(电子版), 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. Kozieł D, Głuszek 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. 金涛, 黄伟, 张潇颖, 等. 急性胰腺炎中西医结合诊疗指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
28. 余莹, 程健. 重症急性胰腺炎“腑气不通”的中医病机本质探讨. 中国疗养医学, 2023, 32(1): 32-36.
29. 易志忠, 陈国忠, 袁铁超, 等. 大承气汤治疗重症急性胰腺炎临床疗效的Meta分析. 中国中医急症, 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. 孙备, 李冠群. 创伤递升式分阶段治疗感染性胰腺坏死再认识. 中国实用外科杂志, 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, Piñero 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, 姜春晖, 郭威, 等. 鼻胃镜和常规胃镜在经皮内镜胰腺坏死组织清除术中的应用对比研究. 中华消化内镜杂志, 2019, 36(11): 815-820.
37. 曹锋, 李昂, 高崇崇, 等. 感染性胰腺坏死分区与腹腔镜手术入路选择临床研究. 中国实用外科杂志, 2020, 40(4): 457-460, 464.
38. 隋宇航, 孙备. 感染性胰腺坏死分型的初探与外科干预策略的再思考. 中华外科杂志, 2021, 59(7): 601-607.
39. 中国中西医结合学会普通外科专业委员会. 重症急性胰腺炎中西医结合诊治指南(2014年, 天津). 中国中西医结合外科杂志, 2014(4): 460-464.
40. 李慧, 陈国忠, 唐曦平, 等. 从“气血津液-络病-肺浊”探讨重症急性胰腺炎肺损伤的动态演变. 吉林中医药, 2023, 43(8): 890-893.
41. 郑俊全. 血府逐瘀口服液联合生长抑素治疗急性胰腺炎的临床研究. 现代药物与临床, 2014, 29(8): 907-910.
42. 高世平, 刘涛, 张玲等. 桃核承气汤联合早期多部位穿刺置管引流治疗重症急性胰腺炎的临床研究. 世界中西医结合杂志, 2018, 13(8): 1132-1135, 1139.
43. 祝涛, 钮宏文. 自拟消炎汤辅助经皮穿刺置管引流术治疗急性胰腺炎合并胰腺周围组织坏死感染的疗效观察. 中国中医急症, 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. 杜烨湘, 罗敏, 冯敏, 等. 甘草素通过抗炎发挥对阿尔茨海默病的保护作用. 免疫学杂志, 2019, 35(4): 327-333.
47. 李月阳, 雷根平, 董盛, 等. 柴胡的现代药理作用研究进展. 海南医学院学报, 2022, 28(22): 1748-1754.
48. 孔令青. “中西医协同”是中西医结合研究的一项重要内容. 中西医结合研究, 2016, 8(2): 104-106.

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

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