Research On Evidence Classification And Evidence-based Evaluation Of Bee Acupuncture High Frequency Disease Based On GRADE System

Objective: To use the ideas and methods of bibliometrics and the GRADE system of evidence-based medicine comprehensively,summarize comprehensively and analyze scientifically the literature on bee acupuncture therapy at home and abroad,establish a high-quality spectrum of diseases intervened by bee acupuncture therapy,analyze its characteristics and development trends,and analyze its characteristics and development trends.From the perspective of clinical evidence grading,the GRADE grading method was used to grade the evidence for the top three high-frequency diseases,and the clinical efficacy of bee acupuncture therapy was analyzed comprehensively,to provide a reference for clinical work.Methods: Computers were used to comprehensively search large domestic and foreign databases such as China Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),Wanfang Digital Journal Group(WF),VIP Database(VIP),Pubmed database,Embase database,and Cochrane Library database.The authoritative database,supplemented by manual retrieval to obtain the clinical research literature on the intervention of bee acupuncture therapy,gradually builds the disease spectrum of bee acupuncture therapy intervention.The Bibliometrics method was used to extract the disease name,publication year,intervention measures,literature sources,literature types,keywords,authors and author units,etc.included in the literature,and the Citespace software was used to analyze the disease spectrum characteristics of bee-acupuncture therapy intervention.Based on the GRADE system analysis method of evidence-based medicine,the top three high-frequency diseases were selected from the disease spectrum included in the bee acupuncture therapy and were classified into four levels of evidence: high,medium,low,and very low.That is,first select the top three high-frequency diseases clinical literature and sort out the basic characteristics,use Rev Man 5.3 software to conduct a Meta-analysis on randomized controlled trials literature with strong homogeneity,and then use the GRADE system to analyze The aggregated outcome indicators used to evaluate the quality of evidence.During the grading process,the criteria for upgrading and downgrading must be grasped,including 3 upgrading conditions and 5 downgrading conditions.Result:(1)Bee acupuncture therapy applies to a wide range of diseases.A total of 962 clinical literature have been included,covering 245 diseases and distributed in 17 disease systems,among which musculoskeletal system and connective tissue diseases rank first,followed by nervous system diseases and respiratory diseases.Systemic diseases and genitourinary system diseases,high-frequency diseases include rheumatoid arthritis,ankylosing spondylitis,osteoarthritis,frozen shoulder,and arthralgia.(2)In terms of the characteristics of the clinical literature on bee acupuncture therapy,(1)the number of published clinical research papers on bee acupuncture therapy has been at a relatively low level from 1959 to 1991 and has developed from rapid growth to fluctuating growth since 1992.It reached its peak in 2019,thanks to the help of the Bee Acupuncture Therapy Exchange Conference.(2)The four teams represented by Li Wanyao,Cheng Yongming,An Xiangzhen,and Duan Xiaorong are the most dynamic and influential in the research field of bee acupuncture therapy,and the research institutions are relatively concentrated in Guangzhou University of Traditional Chinese Medicine and its affiliated hospitals,Fujian Agriculture and Forestry University and Shijiazhuang Dazheng Zhong Apitherapy Hospital and other institutions have little influence;the intimacy of cooperation between teams and between institutions is not high,and the interaction is poor.(3)Literature and publications mainly come from industry-leading journals such as "Bee Magazine","Chinese Bee Industry","Beekeeping Science and Technology" and "China Beekeeping",while the proportion of papers published in medical academic journals is small.(4)Judging from the co-occurrence and cluster analysis of keywords in the included literature,which method of bee acupuncture intervention has the best clinical curative effect is one of the key points of exploration.(5)Judging from the emergence of keywords and timeline analysis of the included literature,innovative bee-acupuncture intervention methods to improve clinical efficacy and control adverse reactions have become research hotspots and development directions.(3)From the systematic review and GRADE classification of bee acupuncture therapy for rheumatoid arthritis,compare the clinical efficacy of bee acupuncture with western medicine,bee acupuncture combined with western medicine and western medicine in the treatment of rheumatoid arthritis,through Meta analysis It showed that the treatment of rheumatoid arthritis with bee acupuncture alone can only improve the effective rate [RR=1.11,95%CI(1.03,1.19),P=0.003 <0.01],reduce the VAS score [MD=-1.56,95%CI(-2.85,-0.28),P<0.00001] and other two aspects were significantly better than the western medicine group,and the treatment of rheumatoid arthritis with bee acupuncture combined with western medicine could improve the effective rate [RR=1.20,95%CI(1.11,1.29),P<0.00001],reduce VAS score[MD=-15.86,95%CI(-18.97,-12.75),P<0.00001],reduce ESR in serum [MD=-11.07,95%CI(-16.11,-6.03),P<0.00001],CRP[MD=-7.11,95%CI(-9.73,-4.48),P<0.00001],RF[MD=-0.24,95%CI(-0.43,-0.05),P=0.01<0.05] and improved morning stiffness[MD=-0.70,95%CI(-1.24,-0.16),P=0.01<0.05] and other 6 aspects were significantly better than the western medicine group.In addition,bee needle alone can reduce serum RF[MD=-0.09,95%CI(-0.25,0.07),P=0.25>0.05],CRP[MD=0.49,95%CI(-1.30,2.29),P=0.59>0.05],ESR[-6.86,95%CI(-15.01,1.28),P=0.10>0.05] and improved morning stiffness[MD=-0.66,95%CI(-1.70,0.37),P=0.21>0.05],there was no significant difference with the western medicine group.Sensitivity analysis found that there was a certain risk of publication bias in the total effective rate.Through the GRADE system,the five aspects of effective rate,VAS,ESR,CRP,RF,and morning stiffness were graded,and found that effective rate and RF were low-quality evidence,and VAS,ESR,CRP,and morning stiffness were extremely low-quality evidence.(4)According to the systematic review and GRADE classification of bee acupuncture treatment for osteoarthritis,the clinical efficacy of bee acupuncture and other non-bee acupuncture interventions in the treatment of osteoarthritis were compared.Arthritis can improve the effective rate [RR=1.17,95%CI(1.12,1.23),P<0.00001],improve the HSS score [MD=3.85,95%CI(1.88,5.82),P=0.0001<0.01],Reduce pain [MD=-1.27,95%CI(-1.64,-0.89),P<0.00001],improve stiffness[MD=-1.06,95%CI(-2.07,-0.05),P=0.04<0.05 ] and joint function [MD=-5.39,95%CI(-7.34,-3.43),P<0.00001] were significantly better than those in the control group,but in reducing the VAS score [MD=-0.91,95%CI(-1.88,0.05),P=0.06>0.05],there was no difference with the control group;the funnel plot was used to evaluate the publication bias of the total effective rate,and it was found that there was a certain risk of bias,but the sensitivity analysis showed that the results were more stable.Through the GRADE system,the six aspects of effectiveness,VAS,HSS,pain,stiffness,and joint function were graded according to the level of evidence,and it was found that the pain level was medium-quality evidence,the effective rate,and joint function were low-quality evidence,and VAS,stiffness,and joint function were low-quality evidence.Evidence for HSS and stiffness was very low quality.(5)From the perspective of systematic review and GRADE classification of bee acupuncture therapy for ankylosing spondylitis,compare bee acupuncture and western medicine,bee acupuncture combined with western medicine and western medicine,bee acupuncture and other non-bee acupuncture interventions in the treatment of ankylosing spondylitis According to the clinical curative effect of ankylosing spondylitis,the meta-analysis shows that single use of bee needles in the treatment of ankylosing spondylitis can improve the effective rate [RR=0.98,95%CI(0.83,1.16),P=0.84>0.05],reduce the BASDAI score[MD=0.00,95%CI(-0.15,0.15),P=1.00>0.05]and BASFI score[MD=-0.28,95%CI(-0.90,0.35),P=0.38>0.05],etc.However,bee acupuncture combined with Western medicine in the treatment of ankylosing spondylitis can improve the effective rate[RR=1.23,95%CI(1.06,1.42),P=0.005<0.05],reduce the BASDAI score [MD=-1.09,95%CI(-1.64,-0.54),P<0.0001]and BASFI score[MD=-1.10,95%CI(-1.65,-0.55),P<0.0001] were significantly better than those in the western medicine group.In addition,through the publication bias and sensitivity analysis,the total effective rate of the bee needle group has no publication bias and has strong stability;the bee needle can improve the VAS score[MD=-1.03,95%CI(-1.29,-0.78),P<0.00001] was superior to other non-bee needle intervention groups;while bee needles reduced serum ESR levels[MD=-0.90,95%CI(-3.23,1.42),P=0.44>0.05] and CRP levels[MD=0.59,95%CI(-0.70,1.88),P=0.37>0.05] There was no significant difference with other non-bee-needle intervention groups,and the six aspects of effective rate,BASDAI,BASFI,ESR,CRP,and VAS were evaluated by the GRADE system.Evidence level grading found that effective rate and VAS were low-quality evidence,and BASDAI,BASFI,ESR,and CRP were very low-quality evidence.Conclusion:(1)Bee acupuncture therapy has a wide range of clinical indications,relatively concentrated in the musculoskeletal system and connective tissue disease system,among which rheumatoid arthritis,ankylosing spondylitis,and osteoarthritis are the most frequently used;innovative bee acupuncture intervention methods to improve clinical Efficacy and control of adverse reactions are research hotspots and future trends,but there are still problems such as relatively concentrated scientific research teams,low cooperation and intimacy,and weak academic results;in the future,cooperation should be strengthened to form a research community for apitherapy and expand research on apitherapy scope.(2)Bee acupuncture therapy has a definite clinical curative effect on three high-frequency diseases such as rheumatoid arthritis,osteoarthritis,and ankylosing spondylitis.Among them,bee acupuncture combined with Western medicine has the most obvious advantages,which can effectively enhance clinical efficacy,but the quality of evidence included in the literature It is low,mainly based on low-level and extremely low-level evidence.More high-quality RCTs are urgently needed to provide support,Seizing the key issues of intervention elements,study subjects,bias control and index selection of bee-acupuncture therapy,we designed a reliable,scientific and feasible high-quality RCT clinical study by standardizing interventions,innovative loading experiments,multidimensional design of nadir,correct randomization grouping,serious ethical review,strict data management,unified measurement tools,integration of TCM evaluation methods,construction of a comprehensive index system and strict standardization of clinical trial reports,reduce bias as much as possible,and provide a reference and decision-making basis for clinical users,to improve the clinical application of bee acupuncture therapy.Quality in use.