基于“肠–胰轴”的中医药调节肠道菌群治疗急性胰腺炎研究进展

Research Progress on Traditional Chinese Medicine Regulating Gut Microbiota in the Treatment of Acute Pancreatitis Based on the Gut-Pancreas Axis

摘要: 急性胰腺炎(AP)是临床常见的急腹症，重症患者病死率高，而肠道菌群在AP发生和重症化过程中发挥着重要作用，肠道菌群失调则会破坏肠屏障、诱发细菌或内毒素易位，从而激活全身炎症。“肠–胰轴”概念的提出为理解肠道与胰腺的双向通讯提供了新框架。近年来，一些高质量证据，包括多项Meta分析、孟德尔随机化研究及网络药理学分析，证实了中医药复方及单味药物可通过调节肠道菌群、修复肠屏障、抑制炎症信号通路(如NF-κB、PI3K/AKT、MAPK等)有效治疗AP。本文系统梳理“肠–胰轴”的现代科学内涵，整合高级别临床证据与多组学机制研究，并探讨中医“通腑泻下”“毒热”理论与“菌群–代谢–免疫”轴的内在契合，为AP的中西医结合防治提供新思路。

Abstract: Acute pancreatitis (AP) is a common acute abdominal condition in clinical practice, with high mortality among patients with severe disease. Gut microbiota dysbiosis plays a pivotal role in the onset and progression of AP by disrupting the intestinal barrier, inducing bacterial or endotoxin translocation, and subsequently activating systemic inflammation. The concept of the “gut-pancreas axis” provides a new framework for understanding the bidirectional communication between the intestine and the pancreas. In recent years, high-quality evidence, including multiple meta-analyses, Mendelian randomization studies, and network pharmacology analyses, has confirmed that traditional Chinese medicine formulas and single herbs can effectively treat AP by modulating gut microbiota, repairing the intestinal barrier, and inhibiting inflammatory signaling pathways (NF-κB, PI3K/AKT, MAPK). This article systematically reviews the modern scientific connotation of the gut-pancreas axis, integrates high-level clinical evidence and multi-omics mechanistic studies, and explores the intrinsic alignment between the traditional Chinese medicine theories of “purging the fu-organs and draining downward” and “toxin-heat” with the “microbiota-metabolism-immunity” axis, aiming to provide new insights for the integrated traditional Chinese and Western medicine management of AP.