| OBJECTIVE:To comprehensively evaluate the effectiveness, clinical safety and economics of different Acupuncture and Moxibustion therapies in treating herpes zoster, and screened out the advantaged program of treating herpes zoster, which could provide the references for clinical physicians to choose effective, safe and economic medical scheme.METHODS:Based on a multi-center,randomized-controlled trial, by the random system,this study randomly allocated five hundreds cases of patients with herpes zoster who met the inclusion criteria into five groups:Group A (Basic Acupuncture Therapy Group), Group B (Cotton-sheet Moxibustion Therapy group), GroupC (Fire needle therapy group), Group D (Tapping and cupping therapy group) and Group E (Western medicine therapy group). The clinical treatment would last for 10 days, and the follow-up visit would be set on the 22nd,30th and 60th day after treatment. Cura-tive effect was evaluated by comprehensive efficacy score, blister index, pain index, etc; Follow-up efficacy was determined by comprehensive efficacy score, Visual Analogue Score(VAS) and the incidence of postherpetic neuralgia (PHN); Safety indexs used to evaluate security; while the clini-cal economic evaluation used cost-effectiveness ratio.RESULTS:1. The Efficacy Evaluation(1) Comparison of Comprehensive Effect①Comprehensive Efficacy ScoreThere were significant difference between the anterior and posterior of treatment on comprehen-sive efficacy score among five groups (P<0.05). On the 5th day during the treatment period, the im-provement comprehensive efficacy score of Group A and C were better than Group B and Group E, the difference was significant(P<0.05).②Total Effective RatesThe total effective rates were as follow:Group A 97.87%, Group B 97.87%, Group C 93.41%, Group D 92.63%, Group E 97.89%. There was no significant difference among the five groups.③Dynamic Oservation of the Efficacy From the 3rd day to the 6th day, the total effective rates of Group A, B and C were better than Group E(P<0.05). From the 5th day to the 6th day, Group B’s total effective rate was superior to Group E(P<0.05). On the 3rd day, Group A,C and D’total effective rates were better than Group B, (P<0.05). By comparison, total effective rates of Group C and D were better than Group B on the 4th day(P<0.05). From the 7th day to the 10th day, the total effective rates of the five groups had no significant diffenrence (P>0.05)(2) Comparison of Herpes Evaluation Index:The time of new blister ceasing, old herpes incrustation and decrustation among the five grou-ps had no significant difference(P>0.05).(3) Comparison of Pain Evaluation Index①There were significant diffenrence on pain duration time among the five groups (P<0.05) Group A,B,C and D were superior to Group E.②There were significant difference on VAS between the pro-and -post treatment among the five groups(P<0.05). After treatment, VAS scores of Group A, B, C and D were lower than Group E, which has significant difference(P<0.05).③Dynamic Observation on VAS Scores:Pain intensity(PI) decreased overall. From the 3rd day to the 10th day, VAS scores of Group A and B was significantly lower than Group E(P<0.05). From the 2nd day to the 10th day, VAS scores of Group C and D was significantly lower than Group E(P<0.05). Group C’s VAS scores was significantly lower than B group on the 2nd day(P<0.05).(4) Comparison of Single Index①"Partial pain" Index:On the 10th day, the disappearance rate of partial pain of Group A, B, C and D were higher than Group E, which has significant difference(P<0.05).②"Number of blisters" Index:On the 5th day of the treatment, the disappearance of blister number of the four acupuncture groups were more than Group E(P<0.05),and Group C’s number of blister was higher than Group A and B (P<0.05) while the blister number of Group D was higher than Group B (P<0.05).AND those difference had statistical significance.③"Number of blister-clusters" Index:On the 5th day, disappearance rate of blister-clusters number of the four acupuncture groups were higher than Group E(P<0.05), which had significant difference:The blister-clusters number’s disappearance rate of Group C and D were higher than Group B(P<0.05). 2. Follow-up Observation(1) The comparison of Cure rateOn the 22nd day, cure rate of Group A,B, C, D were better than Group E, and there were significant difference(P<0.05).(2) The comparison of VAS scoresOn the 22nd,30th and 60th day during follow-up visit period, VAS scores of the the four acupuncture groups were lower than Group E, which had significant difference(P<0.05).(3) The comparison of the incidence of postherpetic neuralgia(PHN)The incidence of postherpetic neuralgis of Group A, B, C and D were significantly lower than Group E on the 30th day of the treatment (P<0.05).(4) Logistic regression analysis of PHN:Single and multiple regression analysis showed age corresponding Exp(B)=OR=1.035>1, P=0.01, had significant difference (P<0.05), while VAS scores before treatment corresponding Exp(B)=OR=1.028>1, P=0.02 also had significant differe-nce(P<0.05).3. Comparison of safety index:The incidence of adverse events among the four acupuncture groups had no significant differen-ce (P>0.05). There were no significant differenrence on safety index of all the five groups(P>0.05).4. Comparison of clinical economics:Compared with western medicine therapy group (Group E), each precedent day of pain relief among four needle groups could separately retrench 21.90yuan,21.87yuan,26.00 yuan and 20.23 yuan RMB.CONCLUSION:1. The comprehensive efficacy of the four acupuncture groups all had definite therapeutic effect, and the onset of the acupuncture-moxibustion therapise were earlier than western medicine group. Thereinto, the onset time of basic acupuncture group, tapping and cupping group and fire-needle group were ealier than cotton-sheet moxibustion therapy group.2. These Four acupuncture therapy groups were better than western medicine therapy group on releasing pain and improving the symptoms of blisters, In releasing pain of the Herpes Zoster, Fire needle Therapy was superior to Cotton-sheet Moxibustion Therapy. In improving numbers of herpes zoster symptom, Fire needle Therapy was superior to Basic Acupuncture Therapy and Cotton-sheet Moxibustion Therapy while Tapping and Cupping Therapy superior to Cotton-sheet Moxibustion.3. The following-up cure rate, intensity of pain relief and the incidence of postherpetic neuralgia of four acupuncture therapy groups were better than western medicine therapy group.4. Four Acupuncture Therapies were all relatively safe.5. Cost-effectiveness of the four acupuncture therapy groups were more reasonable than Western medicine treatment.Besides, fire needle acupunture is the most economic one. The advantage program of treating herpes zoster in summary is as follow:①In the condition of severe pain with numbers of blister, fire needle acupuncture, tapping and cupping therapy are recommended.②If the chief complaint is pain, we recommend fire needle acupuncture, tapping and cupping acupuncture therapy, basic acupuncture.③If the main symptom is blister, fire needle acupuncture, tapping and cupping therapy are recommended.④In order to saving cost, give priority to fire needle acupuncture.⑤Considering quicker effect, advice the fire needle acupuncture, tapping and cupping therapy, basic acupuncture.⑥In conclusion, fire needle acupuncture is recommended. |
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