摘要
急性胰腺炎是临床上最常见的消化系统疾病之一,其发病机制复杂且尚未完全明确,治疗不及时容易进展为重症急性胰腺炎,病情凶险且病死率高。肠黏膜屏障损伤是导致急性胰腺炎加重的关键环节。急性胰腺炎晚期肠黏膜屏障损伤促使肠道内有害菌群移位,细菌及其产生的内毒素进入血液循环引发内毒素血症和肠源性感染,引起多器官功能衰竭,甚至死亡。西医在治疗急性胰腺炎肠黏膜屏障损伤方面存在较大的局限性,而中药通过内服外用多种方式作用于急性胰腺炎肠黏膜屏障损伤的修复,治疗效果确切、肯定,得到广大医师和患者的认可。急性胰腺炎属于中医学的"脾心痛""结胸""胰瘅"等范畴,病因多为过食肥甘厚味,饮食不节、胆石症等导致湿热蕴结中焦,脾胃壅滞,肠腑不通,治疗宜通里攻下,清热解毒,行气活血。该文查阅近5年来国内外相关文献,归纳中药治疗急性胰腺炎肠黏膜屏障损伤的作用机制,可能通过改善肠道微循环障碍、减轻肠道缺血再灌注损伤和氧化应激反应、减少炎症介质和细胞因子的释放、抑制肠上皮细胞的凋亡等保护肠黏膜机械屏障;通过促进胃肠功能恢复,缩短开放肠内营养时间而恢复肠黏膜化学屏障功能;调节肠道菌群微生态失衡而改善肠黏膜生物屏障;调节免疫细胞水平而增强肠黏膜免疫屏障。文章从急性胰腺炎肠黏膜屏障损伤特点、中医治则及中药治疗机制进行综述,旨在为中药治疗急性胰腺炎肠黏膜屏障损伤的深入研究及临床上合理应用提供理论基础和科学依据。
Acute pancreatitis(AP)is one of the most common digestive system diseases in clinic. Its pathogenesis is complex and has not yet been fully clarified. It easily progresses to severe AP if the treatment is not provided in time,and the resulting condition is dangerous with high mortality. Intestinal mucosal barrier(IMB)injury is the key link leading to the aggravation of AP. The IMB injury in the late stage of AP promotes the translocation of harmful intestinal bacteria,the entry of bacteria and the produced endotoxins into blood circulation triggers endotoxemia and enterogenous infection,causing multiple organ failure and even death. Western medicine has limitations in the treatment of IMB injury induced by AP. By contrast,Chinese medicine has been proved effective and reliable in repairing the IMB injury induced by AP through oral administration and external application,and has been widely recognized by physicians and patients. AP falls into the categories of "precordial pain due to spleen disorder", "thoracic accumulation",and "pancreas-heat syndrome" in traditional Chinese medicine. The main causes of AP are excessive intake of sweet and greasy food,improper diet,and cholelithiasis,which lead to damp-heat accumulation in the middle energizer,stagnation of spleen and stomach,and obstruction of fu-organ intestine.Therefore,dredging the interior,purging,clearing heat,removing toxin,moving Qi,and activating blood should be emphasized in treatment. According to the related literature both in China and abroad in the past five years,this paper summarized the action mechanisms of Chinese medicine in the treatment of AP-induced IMB injury as follows:It protects the mechanical barrier by improving intestinal microcirculation disorders,relieving intestinal ischemiareperfusion injury and oxidative stress response,reducing the release of inflammatory mediators and cytokines,and inhibiting the apoptosis of intestinal epithelial cells. It restores the chemical barrier by promoting gastrointestinal functional recovery and shor
作者
韩明
周军
雷霆
HAN Ming;ZHOU Jun;LEI Ting(The First Clinical Medical College of Shaanxi University of Traditional Chinese Medicine(TCM),Xianyang 712000,China;Affiliated Hospital of Shaanxi University of TCM,Xianyang 712000,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2021年第22期232-240,共9页
Chinese Journal of Experimental Traditional Medical Formulae
基金
陕西省自然科学基础研究计划面上项目(2021JM-474)
咸阳市二0二0年中青年科技创新领军人才项目(2020K04-01)
咸阳市二0一八年科学技术研究计划项目(2018K02-100)。
关键词
急性胰腺炎
肠黏膜屏障
中药
机制
综述
acute pancreatitis
intestinal mucosal barrier
traditional Chinese medicine
mechanisms
review
