Difficulties and prospects of combined traditional Chinese and Western medicine in the treatment of severe acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XIA Qing , DENG Lihui , DU Dan , HU Cheng , SHI Na

1. West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

XIA Qing, Email: xiaqing@medmail.com.cn

Keywords：

acute pancreatitis; Chinese medicine; multidisciplinary diagnosis and treatment; combined treatment of Chinese and Western medicine

DOI：

10.7507/1007-9424.202312072

Video：

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Abstract Full text Figures/Tables Video References Cited by

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.

Citation： XIA Qing, DENG Lihui, DU Dan, HU Cheng, SHI Na. Difficulties and prospects of combined traditional Chinese and Western medicine in the treatment of severe acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 129-133. doi: 10.7507/1007-9424.202312072 Copy

1.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
2.	Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol, 2007, 102(12): 2688-2695.
3.	Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg, 2014, 259(6): 1201-1207.
4.	Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut, 2008, 57(12): 1698-1703.
5.	Wu BU, Batech M, Quezada M, et al. Dynamic measurement of disease activity in acute pancreatitis: the pancreatitis activity scoring system. Am J Gastroenterol, 2017, 112(7): 1144-1152.
6.	Paragomi P, Hinton A, Pothoulakis I, et al. The modified pancreatitis activity scoring system shows distinct trajectories in acute pancreatitis: an international study. Clin Gastroenterol Hepatol, 2022, 20(6): 1334-1342. e4.
7.	van den Berg FF, de Bruijn AC, van Santvoort HC, et al. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology, 2020, 20(7): 1302-1311.
8.	Fan L, Hui X, Mao Y, et al. Identification of acute pancreatitis-related genes and pathways by integrated bioinformatics analysis. Dig Dis Sci, 2020, 65(6): 1720-1732.
9.	Blenkiron C, Askelund KJ, Shanbhag ST, et al. MicroRNAs in mesenteric lymph and plasma during acute pancreatitis. Ann Surg, 2014, 260(2): 341-347.
10.	Waldron RT, Lugea A, Gulla A, et al. Proteomic identification of novel plasma biomarkers and pathobiologic pathways in alcoholic acute pancreatitis. Front Physiol, 2018, 9: 1215. doi: 10.3389/fphys.2018.01215.
11.	García-Hernández V, Sánchez-Bernal C, Schvartz D, et al. A tandem mass tag (TMT) proteomic analysis during the early phase of experimental pancreatitis reveals new insights in the disease pathogenesis. J Proteomics, 2018, 181: 190-200.
12.	Wang C, Zhang Y, Tan J, et al. Improved integrated whole proteomic and phosphoproteomic profiles of severe acute pancreatitis. J Proteome Res, 2020, 19(6): 2471-2482.
13.	Papachristou GI, Malehorn DE, Lamb J, et al. Serum proteomic patterns as a predictor of severity in acute pancreatitis. Pancreatology, 2007, 7(4): 317-324.
14.	Peng Y, Hong J, Raftery D, et al. Metabolomic-based clinical studies and murine models for acute pancreatitis disease: a review. Biochim Biophys Acta Mol Basis Dis, 2021, 1867(7): 166123.
15.	Silva-Vaz P, Jarak I, Rato L, et al. Plasmatic oxidative and metabonomic profile of patients with different degrees of biliary acute pancreatitis severity. Antioxidants (Basel), 2021, 10(6): 988. doi: 10.3390/antiox10060988.
16.	Neyton LPA, Zheng X, Skouras C, et al. Molecular patterns in acute pancreatitis reflect generalizable endotypes of the host response to systemic injury in humans. Ann Surg, 2022, 275(2): e453-e462.
17.	Thapa R, Iqbal Z, Garikipati A, et al. Early prediction of severe acute pancreatitis using machine learning. Pancreatology, 2022, 22(1): 43-50.
18.	Kui B, Pintér J, Molontay R, et al. EASY-APP: an artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis. Clin Transl Med, 2022, 12(6): e842. doi: 10.1002/ctm2.842.
19.	Shi N, Liu T, de la Iglesia-Garcia D, et al. Duration of organ failure impacts mortality in acute pancreatitis. Gut, 2020, 69(3): 604-605.
20.	Shen Y, Hu C, Li L, et al. What should be measured and reported in clinical trials for the treatment of patients with acute pancreatitis? A study protocol for establishing a core outcome set. BMJ Open, 2023, 13(12): e075859. doi: 10.1136/bmjopen-2023-075859.
21.	Ren JL, Zhang AH, Kong L, et al. Analytical strategies for the discovery and validation of quality-markers of traditional Chinese medicine. Phytomedicine, 2020, 67: 153165. doi: 10.1016/j.phymed.2019.153165.
22.	Wu X, Zhang H, Fan S, et al. Quality markers based on biological activity: a new strategy for the quality control of traditional Chinese medicine. Phytomedicine, 2018, 44: 103-108.
23.	He J, Feng X, Wang K, et al. Discovery and identification of quality markers of Chinese medicine based on pharmacokinetic analysis. Phytomedicine, 2018, 44: 182-186.
24.	Liu WL, Zhang XL, Fan SQ, et al. A novel concept of Q-markers: molecular connectivity index. Phytomedicine, 2018, 45: 36-40.
25.	Liang G, Yang J, Liu T, et al. A multi-strategy platform for quality control and Q-markers screen of Chaiqin chengqi decoction. Phytomedicine, 2021, 85: 153525. doi: 10.1016/j.phymed.2021.153525.
26.	Wen Y, Han C, Liu T, et al. Chaiqin chengqi decoction alleviates severity of acute pancreatitis via inhibition of TLR4 and NLRP3 inflammasome: identification of bioactive ingredients via pharmacological sub-network analysis and experimental validation. Phytomedicine, 2020, 79: 153328. doi: 10.1016/j.phymed.2020.153328.
27.	Han C, Du D, Wen Y, et al. Chaiqin chengqi decoction ameliorates acute pancreatitis in mice via inhibition of neuron activation-mediated acinar cell SP/NK1R signaling pathways. J Ethnopharmacol, 2021, 274: 114029. doi: 10.1016/j.jep.2021.114029.
28.	杨景喻, 王锐, 金涛, 等. 基于网络药理学探讨大承气汤治疗急性胰腺炎的物质基础和分子机制. 中国中药杂志, 2020, 45(6): 1423-1432.
29.	王锐, 韩晨霞, 彭杨, 等. 基于网络药理学探讨六合丹治疗急性胰腺炎的物质基础和分子机制. 中华胰腺病杂志, 2020, 20(3): 173-182.
30.	Cao F, Xiang J, Wang Y, et al. Chaiqin chengqi decoction alleviates acute pancreatitis by targeting gasdermin D-mediated pyroptosis. J Ethnopharmacol, 2024, 318(Pt A): 116920.
31.	He Y, Hu C, Liu S, et al. Anti-inflammatory effects and molecular mechanisms of shenmai injection in treating acute pancreatitis: network pharmacology analysis and experimental verification. Drug Des Devel Ther, 2022, 16: 2479-2495.
32.	Yang X, Yao L, Yuan M, et al. Transcriptomics and network pharmacology reveal the protective effect of Chaiqin Chengqi decoction on obesity-related alcohol-induced acute pancreatitis via oxidative stress and PI3K/Akt signaling pathway. Front Pharmacol, 2022, 13: 896523. doi: 10.3389/fphar.2022.896523.
33.	Huang Y, Wen Y, Wang R, et al. Temporal metabolic trajectory analyzed by LC-MS/MS based targeted metabolomics in acute pancreatitis pathogenesis and Chaiqin Chengqi decoction therapy. Phytomedicine, 2022, 99: 153996. doi: 10.1016/j.phymed.2022.153996.

1. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
2. Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol, 2007, 102(12): 2688-2695.
3. Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg, 2014, 259(6): 1201-1207.
4. Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut, 2008, 57(12): 1698-1703.
5. Wu BU, Batech M, Quezada M, et al. Dynamic measurement of disease activity in acute pancreatitis: the pancreatitis activity scoring system. Am J Gastroenterol, 2017, 112(7): 1144-1152.
6. Paragomi P, Hinton A, Pothoulakis I, et al. The modified pancreatitis activity scoring system shows distinct trajectories in acute pancreatitis: an international study. Clin Gastroenterol Hepatol, 2022, 20(6): 1334-1342. e4.
7. van den Berg FF, de Bruijn AC, van Santvoort HC, et al. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology, 2020, 20(7): 1302-1311.
8. Fan L, Hui X, Mao Y, et al. Identification of acute pancreatitis-related genes and pathways by integrated bioinformatics analysis. Dig Dis Sci, 2020, 65(6): 1720-1732.
9. Blenkiron C, Askelund KJ, Shanbhag ST, et al. MicroRNAs in mesenteric lymph and plasma during acute pancreatitis. Ann Surg, 2014, 260(2): 341-347.
10. Waldron RT, Lugea A, Gulla A, et al. Proteomic identification of novel plasma biomarkers and pathobiologic pathways in alcoholic acute pancreatitis. Front Physiol, 2018, 9: 1215. doi: 10.3389/fphys.2018.01215.
11. García-Hernández V, Sánchez-Bernal C, Schvartz D, et al. A tandem mass tag (TMT) proteomic analysis during the early phase of experimental pancreatitis reveals new insights in the disease pathogenesis. J Proteomics, 2018, 181: 190-200.
12. Wang C, Zhang Y, Tan J, et al. Improved integrated whole proteomic and phosphoproteomic profiles of severe acute pancreatitis. J Proteome Res, 2020, 19(6): 2471-2482.
13. Papachristou GI, Malehorn DE, Lamb J, et al. Serum proteomic patterns as a predictor of severity in acute pancreatitis. Pancreatology, 2007, 7(4): 317-324.
14. Peng Y, Hong J, Raftery D, et al. Metabolomic-based clinical studies and murine models for acute pancreatitis disease: a review. Biochim Biophys Acta Mol Basis Dis, 2021, 1867(7): 166123.
15. Silva-Vaz P, Jarak I, Rato L, et al. Plasmatic oxidative and metabonomic profile of patients with different degrees of biliary acute pancreatitis severity. Antioxidants (Basel), 2021, 10(6): 988. doi: 10.3390/antiox10060988.
16. Neyton LPA, Zheng X, Skouras C, et al. Molecular patterns in acute pancreatitis reflect generalizable endotypes of the host response to systemic injury in humans. Ann Surg, 2022, 275(2): e453-e462.
17. Thapa R, Iqbal Z, Garikipati A, et al. Early prediction of severe acute pancreatitis using machine learning. Pancreatology, 2022, 22(1): 43-50.
18. Kui B, Pintér J, Molontay R, et al. EASY-APP: an artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis. Clin Transl Med, 2022, 12(6): e842. doi: 10.1002/ctm2.842.
19. Shi N, Liu T, de la Iglesia-Garcia D, et al. Duration of organ failure impacts mortality in acute pancreatitis. Gut, 2020, 69(3): 604-605.
20. Shen Y, Hu C, Li L, et al. What should be measured and reported in clinical trials for the treatment of patients with acute pancreatitis? A study protocol for establishing a core outcome set. BMJ Open, 2023, 13(12): e075859. doi: 10.1136/bmjopen-2023-075859.
21. Ren JL, Zhang AH, Kong L, et al. Analytical strategies for the discovery and validation of quality-markers of traditional Chinese medicine. Phytomedicine, 2020, 67: 153165. doi: 10.1016/j.phymed.2019.153165.
22. Wu X, Zhang H, Fan S, et al. Quality markers based on biological activity: a new strategy for the quality control of traditional Chinese medicine. Phytomedicine, 2018, 44: 103-108.
23. He J, Feng X, Wang K, et al. Discovery and identification of quality markers of Chinese medicine based on pharmacokinetic analysis. Phytomedicine, 2018, 44: 182-186.
24. Liu WL, Zhang XL, Fan SQ, et al. A novel concept of Q-markers: molecular connectivity index. Phytomedicine, 2018, 45: 36-40.
25. Liang G, Yang J, Liu T, et al. A multi-strategy platform for quality control and Q-markers screen of Chaiqin chengqi decoction. Phytomedicine, 2021, 85: 153525. doi: 10.1016/j.phymed.2021.153525.
26. Wen Y, Han C, Liu T, et al. Chaiqin chengqi decoction alleviates severity of acute pancreatitis via inhibition of TLR4 and NLRP3 inflammasome: identification of bioactive ingredients via pharmacological sub-network analysis and experimental validation. Phytomedicine, 2020, 79: 153328. doi: 10.1016/j.phymed.2020.153328.
27. Han C, Du D, Wen Y, et al. Chaiqin chengqi decoction ameliorates acute pancreatitis in mice via inhibition of neuron activation-mediated acinar cell SP/NK1R signaling pathways. J Ethnopharmacol, 2021, 274: 114029. doi: 10.1016/j.jep.2021.114029.
28. 杨景喻, 王锐, 金涛, 等. 基于网络药理学探讨大承气汤治疗急性胰腺炎的物质基础和分子机制. 中国中药杂志, 2020, 45(6): 1423-1432.
29. 王锐, 韩晨霞, 彭杨, 等. 基于网络药理学探讨六合丹治疗急性胰腺炎的物质基础和分子机制. 中华胰腺病杂志, 2020, 20(3): 173-182.
30. Cao F, Xiang J, Wang Y, et al. Chaiqin chengqi decoction alleviates acute pancreatitis by targeting gasdermin D-mediated pyroptosis. J Ethnopharmacol, 2024, 318(Pt A): 116920.
31. He Y, Hu C, Liu S, et al. Anti-inflammatory effects and molecular mechanisms of shenmai injection in treating acute pancreatitis: network pharmacology analysis and experimental verification. Drug Des Devel Ther, 2022, 16: 2479-2495.
32. Yang X, Yao L, Yuan M, et al. Transcriptomics and network pharmacology reveal the protective effect of Chaiqin Chengqi decoction on obesity-related alcohol-induced acute pancreatitis via oxidative stress and PI3K/Akt signaling pathway. Front Pharmacol, 2022, 13: 896523. doi: 10.3389/fphar.2022.896523.
33. Huang Y, Wen Y, Wang R, et al. Temporal metabolic trajectory analyzed by LC-MS/MS based targeted metabolomics in acute pancreatitis pathogenesis and Chaiqin Chengqi decoction therapy. Phytomedicine, 2022, 99: 153996. doi: 10.1016/j.phymed.2022.153996.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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