Meta Analysis And Acupoint Selection Rules On Acupuncture Therapy Of Irritable Bowel Syndrome(IBS)

Objective:To evaluate the efficacy of acupuncture therapy in the treatment of irritable bowel syndrome(IBS)by means of meta-analysis,and to give some suggestions in view of the shortcomings of randomized controlled clinical trials of IBS.At the same time,to study the rule of acupoint prescription of acupuncture therapy in the treatment of IBS by means of cluster analysis.METHODS:Relevant literature retrieval formulas were formulated:CNKI,CBM,VIP and Wangfang,Pubmed,Embase and ochrane Library.The date of retrieval is from database establishment to January 2019.The Chinese searches were as follows:(acupuncture OR electro-acupuncture OR floating needle OR acupuncture OR needle),AND(irritable bowel syndrome OR gastrointestinal neurosis OR mucinous colitis OR allergic colitis)AND(clinical randomized OR control);and English searches were as follows(Pubmed as an example):((animals[MeSH Terms])NOT((humans[MeSH Terms])AND animals[MeSH Terms]))AND(((((((((((Pharmacopuncture[Title/Abstract])OR Acupuncture Treatment[Title/Abstract])OR Acupuncture TreatmentS[Title/Abstract])OR Treatment,Acupuncture[Title/Abstract]ORTherapy,Acupuncture[Title/Abstract])OR Pharmacoacupuncture Treatment[Title/Abstract])OR Treatment,Pharmacoacupuncture[Title/Abstract])OR Piharmacoacupuncture Therapy[Title/Abstract])OR Therapy,Pharmacoacupuncture[Title/Abstract])OR Acupotomy[Title/Abstract])OR Acupotomies[Title/Abstract])AND(((((((((IrritableBowel Syndromes[Title/Abstract])OR Syndrome,Irritable Bowel[Title/Abstract])OR Syndromes,Irritable Bowel[Title/Abstract])OR Colon,Irritable[Title/Abstract])OR Irritable Colon[Title/Abstract])OR Colitis,Mucous[Title/Abstract])OR Colitides,Mucous[Title/Abstract])OR Mucous Colitides[Title/Abstract])OR Mucous Colitis[Title/Abstract]).According to the inclusion and exclusion criteria,the members of the project draw up a data extraction table to extract the following contents:1.General information,including title,number of cases in the experimental group and the control group,diagnostic criteria,type of irritable bowel syndrome,course of treatment,course of disease,age,School of the acupuncture experimental group,characteristics of manipulation in the acupuncture group;2.Cochrane risk bias assessor The literature quality evaluation table includes author,publication date(year),random allocation method,allocation concealment,blind method,and the existence of incomplete data.Third,the specific items and scores of Jadad score.Data were extracted from the outcome indicators of the literature included in the study,and Meta-analysis was carried out using RevMan 5.3 statistical software provided by Cochrance Collaboration Network.(1)Odds ratio(OR)was used as the statistical analysis of therapeutic effect,mean difference(MD)was used as the measurement data,and 95%confidence interval(Cl)was used for each effect;(2)Heterogeneity test:2 test was used to test the statistical heterogeneity among the studies,when there was no heterogeneity among the studies(P<0.10,I<50%),fixed.The effect model was used for data statistical analysis.When heterogeneity existed among the studies(P<0.10,I 2>50%),the random effect model was used for data statistical analysis,(3)Stability analysis:Z test was used to compare the main and secondary outcome indicators of the experimental observation group and the experimental control group.When P<0.05 was considered to have statistical significance,the results were described by forest map.Research on the law of acupoint selection in literature.The research methods were CNKI,CBM,VIP and Wangfang,Pubmed,Embase and Chorane Library.The inclusion and exclusion criteria mentioned in this study were screened,and the information eventually included in the literature was extracted and preprocessed,and the irritable bowel was established.Syndrome prescription database,using SPSS 17.0 cluster analysis,to get the clinical acupoint selection rules of acupuncture treatment for irritable bowel syndrome.RESULTS:In this literature search,there were 313 CNKI searches,104 CBM searches,230 Wanfang databases,20 Weipu databases,3 Pubmed databases,3 Ermbases,80 Cochrance Libraries and 753 Cochrance Libraries.After reading the title and,370 papers were deleted and 278 duplicated papers were excluded.After reading the full text of the literature,20 papers were found to be inconsistent with the inclusion criteria.Finally,85 papers were included according to the criteria.There are 85 papers included in this study.’41 papers refer to the generation of detailed random allocation schemes using random number table method,which achieves the principle of random allocation.44 papers only refer to random but do not specify specific random methods.In these 44 papers,there is no specific means of allocation,and it is impossible to judge whether random allocation can be achieved.In terms of covert grouping,84 papers all refer to random allocation.It is not clear whether hidden grouping has been implemented or not.One document 1s a high-risk document,which can be identified according to the reading literature;85 included research literature did not mention the implementation of blind method for patients and doctors,and the evaluation is not clear;85 articles did not mention the implementation of blind method for result evaluation;83 articles have incomplete result data,and 2 documents have incomplete results.Data;Selective outcome reports and other bias:No other types of bias were found in 85 articles.In terms of JADAD score,only two of them scored 5 points,13 scored 4 points,26 scored 3 points,36 scored 2 points and 8 scored 1 point.According to the standard of JADAD score,only 15 of the 85 papers included in this study were of high quality.JADAD score was greater than or equal to 4 points,while the remaining 70 papers were below 4 points.Overall,the quality of the papers included in this study was general.Meta-analysis showed that the experimental group with acupuncture as the main treatment had better scores in efficiency,recurrence rate,clinical symptom score and SF-36 than the control group.In addition,there was no evidence that the experimental group was better than the control group in the evaluation of insomnia and amnesia score,vasoactive intestinal peptide,serotonin,SDS and other indicators in SF-36.Clustering analysis refers to the process of grouping the set of physical or abstract objects into multiple classes composed of similar objects,and can divide the research objects into relatively homogeneous groups.SPSS 17.0 statistical software was used to cluster and analyze the acupoints with the frequency of Da 3.The 24 acupoints were divided into three categories:Sanyinjiao-Shangjuxu-Taiehong,Tianshu一Zusanli and Baihui-Yintang,Pishu-Ganshu一Gongsun一Xingjian一Quchi-Zhigou一Daheng一Shenshu－Yinlingquan.Xia Wan-Hegu-Xia Juxu-Qi Hai-Neiguan-Guan Yuan,Dao Dao Yu and Zhong Wan belong to one category respectively.Conclusion:1.This meta-analysis included 85 RCT studies and 7059 patients.Meta-analysis showed that the overall effectiveness of the experimental group was better than that of the control group(P<0.00001).In terms of recurrence rate,the total recurrence rates of the experimental group and the control group were 102/296(34.46%)and 140/282(49.65%)respectively.The recurrence rate of the control group was higher than that of the experimental group based on acupuncture therapy,indicating that the experimental group was mainly treated by acupuncture.After treatment,the recurrence rate of irritable bowel syndrome was lower than that of the control group.The clinical symptoms scores of abdominal pain,abdominal pain relief efficiency,tinnitus clinical symptoms score,dry stool syndrome score,stool characteristics clinical symptoms score,diarrhea clinical symptoms score,abdominal distension clinical symptoms score,abdominal distension relief efficiency,mucus stool clinical symptoms score,defecation frequency clinical symptoms score,depression and irritability clinical symptoms score and total clinical symptoms score between the two groups In terras of mental health score,burnout and fatigue score,body pain score,social function score,physiological function score,anorexia score and overall health score,the experimental group with acupuncture therapy as the main treatment group were lower than those of the control group(P<0.05),indicating that the experimental group with acupuncture therapy as the main treatment group was lower than that of the control group(P<0.05).After the treatment of irritable bowel syndrome,the method has obvious advantages in improving the quality of life of patients;while in the evaluation of some objective indicators,such as Hamilton Depression Scale score,CGRP,NPY,SAS,etc.,the experimental group is better than the control group;in addition,there is no evidence for the evaluation of insomnia and amnesia score,vasoactive intestinal peptide,serotonin,SDS and other indicators in SF一36.The experimental group was better than the control group.2.According to the results of frequency analysis and cluster analysis,acupoints such as Tianshu and Zusanli are mainly used in the treatment of irritable bowel syndrome.The acupoint groups are mainly composed of acupoints such as”Sanyinjiao-Shangjuxu-Taichong,and "Tianshu-Zusanli".