Construction And Clinical Observation Of The Mechanism Of Acupuncture At Yingxiang Acupuncture On Allergic Rhinitis

Object:To evaluate the clinical efficacy and safety of acupuncture acupoints of yingxiang in Allergic Rhinitis (AR) and observe the relation between anesthesia and clinical efficacy; based on the hypothesis of Theory of axon reflex of coordination, to build network model of efficacy of acupuncture yingxiang in Allergic Rhinitis and verity from the animal experiments.Methods:1. Using the randomized, single-blind, sham-controlled methods,90 patients which were randomly assigned by computer-generated randomization listed into A group(De Qi sensation expected by acupuncture)and B group(De Qi sensation restricted by acupuncture) and received 12 acupuncture treatment (about 4 weeks) and have a follow-up phase of 8 weeks. The main outcome measures included the primary and secondary indicators. Primary indicators were subjective symptoms scores evaluated by visual analogue scales (VAS) and Rhinconjunctivitis Quality of Life Questionnaires (RQLQ). The secondary indicators were the results of endoscopic and laboratory examinations, such as the serum allergen-specific IgE. With VAS and RQLQ before the treatment, in the 4th and 8th week after the treatment, with C-MMASS after acupuncture everytime, and with nasal endoscopy, serum allergen-specific IgE before and after treatment; The datum were recorded and analysed to assess the efficacy and safety of acupuncture at acupoints in treatment of AR, to evaluate differences of the two groups between the main and secondary indicators, to analyze the correlation of CMMASS and △VAS, △RQLQ score. The use of anti-allergic medication and adverse events were also recorded as one of the secondary indicators.2. Based on the theory of "axon reflex of coordination", Under the assumption that the passways is "acupoint-trigeminal nerve-sphenopalatine ganglion-mucosa of nasal cavity", regulation of "sensory neuropeptides" transformed nerve to the immune network with the point that implementation of nerve transformed to the immune network provides the point, the article analyzed the process of transferring nerve to mucosal immune to build space network of the transmit channel, and to verify the structure and function with the animal experiment.3. The first part of the animal experiments:to dissect the rats, inject horseradish peroxidase (HRP) into yingxiang point, and research the links between yingxiang point and sensorypoint nerve fibers. The second part of the experimengts:Thirty ovalbumin (OVA)-sensitized rats were randomly assigned into the study groupA, the control group B and C, and another 15 rats were used as no-sensitized and no-treatment group. The scores of each group were recorded. Group A were acupunctured at Yingxiang, group B were treated by Simulation of acupuncture, the nasal cavity of group C were blocked by capsaicin, while the group D were the no-treatment group. After two weeks, the four groups of rats were taken blood and nasal mucosa tissue. The content of serum (IL-2,3,4,10,12), granulocyte colony-stimulating factor(GM-CSF), interferon-y(IFN-γ), intercellular adhesion molecule (ICAM-1), tumor necrosis factor(TNF-α), vascular venzyme-linked immunoassay ((ELISA). The sensory neuropeptides, (substance P, SP) calcitonin gene related peptide (CGRP) were measured by immunohistochemical detection. To observe:(1) during the building and treatment of allergic rhinitis rats, the behavior score changes of AR rats during modeling and treantment time. (2) The difference of content in inflammatory medium, cytokines and immunoglobulin E after the intervention. (3) Nasal mucosa sensory neuropeptides integral optical density value of rats.Results:1. The clinical efficacy and safety of acupuncture at acupoints for allergic rhinitis(1) The baselines of the two groups showed statistical differences.(2)Effectiveness evaluation of acuesthesia:the two groups were both significantly improved in CMMASS score, the numbers and total cases (P<0.05).(3) The VAS sores:The score of total symptom:Between the two groups, there was significantly difference in general (P<0.05).In inter group comparison, After a period of treatment, the end of treatment and the end of follow-up treatment, the difference was significant(P<0.05), while there was no significant difference between the end of treatment and the end of follow-up treatment(P>0.05). The score of every symptom:Between the two groups, there was significant differences between the two groups after treatment and follow-up period (P<0.05) in nasal itching, sneezing and qing stuff.In inter group comparison, after the end of treatment and the end of follow-up treatment,the scores of every symptom in both the group A has significant differences(P<0.05), while there was no significant difference between the end of treatment and the end of follow-up treatment(P>0.05). The scores of nasal itching and sneezing in group A has significant differences (P<0.05), while there was no significant difference in other symptoms (P>0.05).(4) The RQLQ scores for group A and group B were both significantly improved after the treatment (P< 0.05), and the improvements in group A were significantly better than those in group B after the treatment and follow-up treatment (P< 0.05),while the scores were no difference between the end of treatment and follow-up treatment(P>0.05).(5) For endoscopic examination, before the treatment, the two groups were no significant differences (P>0.05). there were significantly improved after the end of treatment and follow-up treatment in the two groups (P<0.05)(6) The correlation of CMMASS and △VAS (the score before and after treatment),△RQLQ (the score after treatment):the fitting degree of CMASS and AVAS was 0.617, regression equation:Y= 2.148+0.137 X. The fit of the score is 0.485, the regression equation, Y= 2.797+0.986 X. The two groups were positive regression trend.(7) The levels of serum specific IgE were significantly improved for group A after treatment (P< 0.05), while the group B was no significant differences after treatment (P>0.05).In inter group comparison, the differences of serum specific IgE were significant between the two groups either before or after the treatmentC(P<0.05).(8) During the period of treatment and follow-up,3 patients in group A were out of experiment, and the group B had 5 patients out of experiment.(9) No adverse events occurred in group A or group B in the treatment.2. Regulatory effect of catgut implantation at acupoint on neurogenic Inflammation in Rat Animal Model with Allergic Rhinitis(1) Symptoms of allergic rhinitis were remarkably relieved after the treatment of catgut implantation at acupoints.(2) Nerve tracer study of yingxiang:A large number of particles of color reaction were found in yingxiang point of rats after 2 days. Maxillary branch of trigeminal nerve, the trigeminal nucleus of solitude, and butterfly palate ganglion exited in the cell body of the neuron and synapse after 7days.(3) Cytokines detection:interleukin in rats was compared in pairs (group A, B, C, D). As interleukin (IL-2), there was significant difference after treatment except group A and C. As interleukin (IL-3), there was no significant difference between groups (P> 0.05). As interleukin (IL-12), there was significant difference after treatment except group A and C. As TFNF-α, in addition to the B and D, C and D, and the rest groups were no significant difference (P> 0.05). As ICAM-1, the data B and C had no significant difference (P>0.05), and the rest of the groups were significant difference (P<0.05). As GM-CSF, the date of A and B, A and C, B and C had no significant difference(P> 0.05). There was no significant difference in IFN-y (p>0.05).(4) Sensory neuropeptide immunohistochemical and Integral optical density value study revealed a marked decrease of substance P (SP), calcitonin gene related peptide (CGRP) after treatment. There was significantly difference in the four groups (p<0.001).Conclusion:1. A group (De Qi sensation expected by acupuncture) and B group (De Qi sensation restricted by acupuncture) both could relieve the symptoms of patients with allergic rhinitis (VAS score) and improve quality of life (RQLQ score). The observational group had an obvious advantage than control group in acuesthesia, VAS score, RQLQ score and the improvement of signs. The score of CMMASS was high positively related to VAS、RQLQ.2. The experiment of neural tract tracing of yingxiang point showed that the hypothesis of "yingxiang-trigeminal nerve-the butterfly palate ganglion-nasal mucosa" was feasible in structure.3. The experiment which detected nerve peptide active substances and cytokines, such as nasal mucosa SP and CGRP, found that acupuncture can obviously reduce rat nasal mucosa SP, CGRP and then adjust a variety of cytokines in AR rats model.