| ObjectiveTo evaluate the clinical efficacy of intranasal acupuncture in the treatment of allergic rhinitis(AR),and to explore the neuroimmunological control mechanism of allergic rhinitis in the treatment of allergic rhinitis based on "neurogenic inflammation",from clinical and basic provide scientific basis for the clinical application of intranasal acupuncture treatment.Methods1 Randomized controlled clinical trials were used to divide persistent moderate-to-severe AR subjects who met the inclusion criteria into experimental group(intranasal acupuncture group)and control group(Western medicine treatment group).Subjects in the experimental group received a total of 6 intranasal acupuncture treatments every other day;the control subjects were given oral loratadine(10 mg Qd)+nasal spray budesonide nasal spray(64 μg per nostril).Bid),continuous treatment for 12 days.Visual Analogue Scale(VAS)and Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)were the main efficacy evaluation indicators;serumspecific Immunoglobulin E(IgE),Substance P(SP),Vasoactive intestinal peptide(VIP),Neuropeptide Y(NPY),and other laboratory indicators are used as indicators of intranasal acupuncture neuroimmunological mechanisms.Adverse reactions of the subjects during the treatment will also be recorded.Subjects in the experimental group were scored before treatment and after each treatment;the clinical efficacy and safety of intranasal acuPuncture were evaluated.The control group scored before and after the treatment.Nasal secretions and peripheral blood were collected from both groups before treatment and after treatment.The contents of SP、VIP、NPY and IgE were used to investigate the neuromodulatory mechanism of AR treated by intranasal acupuncture by Elisa method.2 Animal models of allergic rhinitis in New Zealand rabbits were prepared by ovalbumin sensitization method.They were divided into group A(normal group),group B(model group),group C(sham acupuncture group),group D(acupuncture welcome Fragrance group)and E group(intranasal acupuncture group).Eight New Zealand rabbits in each group(3 in the late normal group and 1 in the sham acupuncture group).The normal group and the model group were not interfered.The sham acupuncture group used non-acupoint shallow acupuncture to intervene,acupuncture Yingxiang group acupuncture Waiyingxiang acupuncture,and intranasal acupuncture acupuncture the outer turbinate upper margin(neation Yingxiang acupoint).In the last three groups,the needles were kept for 30 minutes every other day for a total of 7 times.On the second day after treatment,peripheral blood of New Zealand rabbits was taken from each group and nasal mucosa was fixed.Observe the following:changes in behavioral scores related to allergic rhinitis in New Zealand rabbits during modeling and treatment;detection of IgE,IL-4,and IFN-y levels in peripheral blood by Elisa;detection of SP,VIP in nasal mucosa by immunohistochemistry,NPY immunohistochemical staining and the average optical density values were determined.Combined with the results of this part of the study and clinical laboratory laboratory test results,preliminarily explore the mechanism of neuro-immunity regulation of allergic rhinitis by intranasal acupuncture.Results1 Clinical efficacy of allergic rhinitis treated by intranasal acupuncture(1)The evaluation results of VAS scale showed that the differences of VAS scores between the two groups after treatment and between groups were statistically significant(P<0.05).2 The degree of relief of nasal symptoms was better in the experimental group than in the control group.3 Comparison of the results of the lateral group of the experimental group showed that there was a significant difference(P<0.01)between the VAS scores before treatment,1 hour after the first treatment,and the rest of the time points,suggesting that the AR patients had symptoms after the first intranasal acupuncture treatment.Can be significantly relieved within 1 hour.There was no significant difference in the VAS scores after the first and second treatment(P>0.05).It can be seen that the improvement of symptoms was not obvious before and after the second treatment.The difference between the third and fourth scores was again significantly different(P<0.01),indicating that the third treatment effect was satisfactory.There was no significant difference in the fourth,fifth and sixth VAS scores(P>0.05),indicating that the effect of intranasal acupuncture on the improvement of symptoms from the fourth time was lower than before,but the symptoms were still gradually relieved.(2)The results of the RQLQ questionnaire showed that the differences between the RQLQ scale scores before and after treatment in the 12 groups after treatment were statistically significant(P<0.05).2Intranasal acupuncture was superior to western medicine treatment group in improving daily life,nasal symptoms and eye symPtoms.It was slightly better than Western medicine treatment group in improving RQLQ score,mood changes,sleep,and non-nasal-conjunctivitis inflammation.It is slightly inferior to western medicine treatment group in improving related behaviors.(3)Laboratory test indicators:There were significant differences in serum-specific IgE before and after treatment between the 12 groups(P<0.05).There were significant differences between the two groups before and after their own control,serum and intranasal acupuncture groups(P<0.05).There was no significant difference before and after SP and VIP treatment(P>0.05);Western medicine treatment group There was no significant difference between SP and VIP before and after treatment(P<0.05).Regarding nasal secretions,there was a statistically significant difference between the SP and VIP treatments before and after intranasal acupuncture(P<0.05),and there was no significant difference before and after NPY treatment(P>0.05).There was no significant difference before and after treatment with SP,VIP and NPY in the western medicine control group(P>0.05).(4)Safety evaluation:Only 1 case was stopped due to the fainting of the needle during the courseof the experiment,and the other side had an adverse reaction.The patient believes that intranasal acupuncture pain is lighter and can be tolerated.According to the assessment results of patients with bleeding,the degree of bleeding was mostly mild to moderate.2 The effect of intranasal acupuncture on neurogenic inflammation of nasal mucosa in New Zealand rabbits with allergic rhinitis(1)Effect on behavioral scores in New Zealand rabbits with allergic rhinitis:Non-reference test was performed on individual items of sneezing,runny nose,and scratching,and the behavioral differences of allergic rhinitis were compared between the three groups.No statistical significance(P<0.05).(2)Peripheral serum detection index:The comparison of IgE,IL-4,and IFN-y concentrations in each group was statistically significant,and there was a statistically significant difference among the three grouPs:AB,AC,BD,BE,CD,and CE(P<0.005);The differences among AD,AE,BC and DE groups were not statistically significant(P>0.05).(3)Results of immunohistochemistry and average optical density measurements of the three types of neuropeptides:SP and VIP immunohistochemical staining of the nasal mucosa of New Zealand rabbits in both groups 1B and C showed more intracellular brown-yellow particles,even Distribution of slices;New Zealand rabbits in groups A,D,E,New Zealand rabbit nasal mucosa SP,VIP immunohistochemical staining were basically the same,less brown particles in cells,mostly negative staining into a film distribution.The NPY immunohistochemical staining of nasal mucosa of 25 New Zealand rabbits showed more intracellular light yellow particles.The average optical density values were compared by pairwise comparison.There were significant differences among the three groups(AB,AC,BD,BE,CD,CE)(P<0.005).The differences among AD,AE,BC,and DE groups were not statistically significant.(P>0.05).The NPY immunohistochemical staining of nasal mucosa of five groups of New Zealand rabbits all showed intracellular brown-yellow particles.The average optical density of each group was compared by one-way analysis of variance and LSD method.The differences among the five groups were compared.Not statistically significant(P>0.05).Conclusion1 Nasal acupuncture can significantly improve nasal symptoms such as itching,sneezing,runny nose and nasal congestion in patients with AR,and are superior to the control group;intranasal acupuncture can also significantly improve the quality of life of patients with AR.Also better than the control group.The intranasal acupuncture technique has a shorter course of action than the control group and has a rapid onset of action.2 Combining the changes of three types of neuropeptides,IgE and IFN-γ/IL-4 before and after intranasal acupuncture intervention,the possible mechanism of intranasal acuPuncture treatment for AR is to regulate the excitability of local three nerves in the nasal cavity,especially the down regulation.Sensory nerves and parasymPathetic excitability,with corresponding neuropeptides,and SP,VIP mediators,exert their biological effects of regulating immune resPonse and local inflammation,thereby making peripheral blood IgE downregulate and regulating IFN-γ/IL-The equilibrium state of 4 inhibits the dominant response of Th2 cells. |
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