| Purpose:The purpose of this study is to systematically evaluate the efficacy and safety of acupuncture in the treatment of chronic urticaria and to conduct data mining on the compatibility of acupuncture points.Material and method : Randomized controlled study on acupuncture treatment of chronic urticaria was systematically searched in CNKI,VIP,Wanfang,Sino Med,Pub Med,Cochrane Library,EMbase and Web of Science.Two researchers independently screened and extracted the retrieved documents,and used Excel 2010 to record the basic information of the included documents,the results of the risk assessment of the included literature bias,the adverse events related to acupuncture and the specific reasons.The quality of the literature included in the study was evaluated using the Cochrane collaborative network bias risk assessment tool,and the methodology of the study was evaluated using AMSTAR-2.Revman 5.4 software was used for meta-analysis.Using Excel 2010 for frequency analysis of meridian tropism,acupoint characteristics,and distribution sites.Gephi 0.9.2 was used to build a complex network of acupoints involved in the clinical research included in the system evaluation and further explore the rules of acupoint selection.Results:32 randomized controlled studies were included in this study.1.Meta analysis results show that:1.1 In terms of clinical efficacy,acupuncture is superior to western medicine alone[OR=3.46,95% CI:(2.37,5.04)],acupuncture combined with traditional Chinese medicine is superior to traditional Chinese medicine alone [OR=3.81,95% CI:(2.28,6.35)],acupuncture combined with western medicine is superior to western medicine alone [OR=3.55,95% CI:(2.03,6.20)].1.2 In terms of recurrence rate,acupuncture is superior to western medicine alone[OR=0.26,95% CI:(0.13,0.51)].There is no significant difference between acupuncture combined with western medicine and western medicine alone [OR=0.44,95% CI:(0.17,1.14)].1.3 In terms of clinical symptom score,acupuncture is superior to western medicine[MD=-1.71,95% CI:(-2.34,-1.08)],and acupuncture combined with western medicine is superior to western medicine alone [MD=-2.50,95% CI:(-3.66,-1.33)].1.4 In terms of the number of wind masses,acupuncture has no significant difference compared with western medicine alone [MD=-0.55,95% CI:(-1.56,0.45)].In terms of the diameter of wind mass,there is no significant difference between acupuncture and western medicine alone [MD=-0.80,95% CI:(-1.61,0.01)].In terms of itching degree,acupuncture is better than western medicine [MD=-1.25,95% CI:(-2.06,-0.45)].In terms of duration of attack,acupuncture combined with western medicine is better than western medicine alone [MD=-1.09,95% CI:(-1.84,-0.34)].In terms of the score of skin disease quality of life index,acupuncture is better than western medicine[MD=-3.13,95% CI:(-5.11,-1.16)].1.5 In terms of Hamilton Depression Scale,acupuncture is better than sham acupuncture[MD=-1.27,95% CI:(-1.65,-0.90)].1.6 Improving IFN-γ In aspect,acupuncture is better than western medicine[MD=5.91,95% CI:(4.76,7.06)].In terms of improving immunoglobulin E,acupuncture is better than western medicine [MD=-0.92,95% CI:(-1.10,-0.73)].In terms of improving IL-4,acupuncture is better than western medicine [MD=-5.63,95% CI:(-6.59,-4.67)].1.7 In terms of activity score of urticaria,acupuncture is better than western medicine[MD=-0.83,95% CI:(-1.25,-0.42)].1.8 Literature quality: In terms of random distribution,68.75% of the 32 RCTs included used random number table method,while the rest only mentioned random grouping or did not explain how to group;In terms of allocation hiding,only 5 papers describe the hiding methods used in detail;In terms of experimental bias,only 3 articles were low risk;In terms of detection bias,only 4 articles were low risk;In terms of follow-up time,71.9% did not set a follow-up time;In terms of shedding cases,all the literatures reported the number of patients before and after treatment,but only a few literatures reported the number and causes of shedding;1.9 Safety: Of the 32 articles included,1224 patients were treated with acupuncture,and14 articles reported whether there were adverse reactions.Among them,there were 22patients(1.8%)with slight adverse reactions such as bleeding,dizziness,nausea,subcutaneous hematoma,erythema,blister and mild lethargy at the acupuncture site,and no serious adverse reactions were reported.1.10 Methodological quality: The evaluation of AMSTAR-2 shows that the methodological quality of this study is good.2.Data mining results:2.1 From the perspective of acupoint meridians,it can be seen that the two meridians,the Hand Yangming Large Intestine Meridian(38 times)and the Foot Taiyin Spleen Meridian(35 times),are more commonly used,followed by the Foot Yangming Stomach Meridian(21 times),the Foot Taiyang Bladder Meridian(17 times),and the Foot Shaoyang Gallbladder Meridian(13 times).2.2 From the perspective of specific acupoint selection,Wushu acupoint(51 times)is the primary choice for acupuncture treatment of this disease,followed by Jiaohui acupoint(41 times),Yuan acupoint(19 times),Xiahe acupoint(17 times),etc.2.3 From the distribution of acupoints,the upper limb has the highest number of acupoints,up to 12,with a frequency of 49.Next is the lower limbs,with 9 acupoints and a frequency of 62.It is also distributed in the head,neck,chest,abdomen,and back.2.4 Acupoint Compatibility: the complex network of the compatibility of the front and back acupoints involves 38 acupoints,and the important acupoints with high frequency and moderate value,close centrality and intermediate centrality in the complex network include Quchi,Xuehai,Zusanli,Sanyinjiao,Hegu,Fengmen,Fengshi,Fengchi,etc.Conclusion:1.Through meta-analysis of clinical efficacy,recurrence rate,clinical symptom score,itching degree,duration of onset,skin disease quality of life index score and other outcome indicators,it can be concluded that acupuncture treatment for chronic urticaria has good effectiveness;In the 32 included literature,although a small number of patients experienced adverse reactions such as dizziness and bleeding,they were all mild symptoms that could be self alleviated,indicating that acupuncture treatment for chronic urticaria is still safe.However,due to the methodological limitations of inclusion in clinical studies,it is necessary to use large sample,high-quality randomized controlled trials in the future to validate the research results.2.By summarizing the acupoints involved in RCT and excavating the rules of acupoint selection,2.1 Priority should be given to the selected meridians,including the Hand Yangming Large Intestine Meridian,Foot Yangming Stomach Meridian,Foot Taiyin Spleen Meridian,and Foot Taiyang Bladder Meridian.In addition,the Foot Shaoyang Gall Meridian,Governor Meridian,and Ren Meridian should also be added or subtracted as appropriate.2.2 Five Shu acupoints are the most important specific acupoints for acupuncture treatment of chronic urticaria,among which the combined acupoints should be given priority,followed by the intersection acupoints,original acupoints,and lower combined acupoints.2.3 The selection of acupoints is mainly based on the limbs,supplemented by the head,neck,chest,abdomen,waist,and back,which has the effect of strengthening the foundation,regulating qi and blood,and dispelling wind and itching.2.4 In the acupuncture acupoint selection pattern,Quchi,Xuehai,Zusanli,Sanyinjiao,Hegu,Fengmen,Fengshi,and Fengchi are the core acupoints.In clinical practice,it is necessary to increase or decrease according to the actual condition of the patient. |
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