| ObjectiveA systematic review of randomized controlled trials(RCTs)in Chinese and English for acupoint implantation in postherpetic neuralgia(PHN)to assess whether acupoint implantation is a safe and effective treatment for PHN method.Through randomized controlled clinical trials,we will evaluate the clinical efficacy and safety of Professor Lin's innovative Absorbable Suture Floating Implantation on PHN,and provide clinicians with a new method for PHN.Observe the changes in the proportion of Th17 and Treg cells in peripheral blood before and after the treatment of PHN with Absorbable Suture Floating Implantation,and infer the possible immunoregulatory mechanism of floating needle catgut embedding treatment of PHN.MethodThrough 7 medical databases including CNKI,China Biomedical Literature Database,Weipu Journal Database,Wanfang Database,Pub Med,Embase,and The Cochrane Library,we can search for relevant literature on randomized controlled trials about acupoint implantation treatment in PHN from the database to August 31,2021.According to the inclusion and exclusion criteria,the qualified literature was included,and the literature data was extracted and the literature methodological evaluation was performed.Through comparative understanding of the effective rate of acupoint implantation,the Apparent efficiency,the effect and safety of improving the pain index and shortening the pain time.This study took PHN patients as a randomized controlled clinical study.The treatment group used Absorbable Suture Floating Implantation as an intervention measure.Absorbable Suture Floating Implantation is a new type of embedding method that combines floating thorn and embedding modified by Professor Lin.The operation site is the Jiaji points corresponding to the diseased nerve and the local pain site,once every 2 weeks,every two times as a course of treatment,a total of 4 times are completed.The control group was mainly treated by oral corresponding drugs,the oral dose is 75 mg,twice a day,for a total of 8 weeks of treatment.Before treatment,collect baseline data,including general information(name,gender,age,course of disease,whether there is prodromal pain before the onset of herpes zoster,whether there is regular antiviral treatment for herpes zoster,etc.).After the first and second(the 4th week and the 8th week)courses of treatment,the main outcome indicators: VAS score and efficacy evaluation were observed;after the second course of treatment,the secondary indicators: SAS and SDS levels,PSQI and peripheral blood Treg and Th17 cell levels were observed.At the time of specific treatment,the adverse reactions of patients taking pregabalin capsules and floating needle embedding were recorded.ResultThe results of the Meta analysis are as follows:1.Nine studies was included,all Western medicines were used as the control group,with 562 cases,284 cases in the treatment group,and 278 cases in the control group,by reporting baseline conditions.Among them,Seven studies(with a total of 439 cases)reported gender,age,and disease course according to the treatment group and the control group.Six studies compared the previous VAS scores.After meta-analysis,these studies were comparable in terms of gender,age,course of disease,and VAS score before treatment.2.The nine included studies all compared the effective rate,and 8 of them compared the apparent cure rate.The meta-analysis showed The effective rate and apparent rate of the treatment group were significantly higher than those of the observation group.It shows that the comprehensive curative effect and obvious efficiency of acupoint implantation on PHN are better than the western medicine group.Six studies were included to conduct free-effect Meta analysis of VAS scores before and after treatment.The analgesic effect of acupoint implantation was significantly better than that of the western medicine group(P<0.0001);two studies were included,and the results of META analysis showed that the pain improvement time of the treatment group was significantly lower than that of the control group.Group(combined Mean=-3.23,P<0.00001),indicating that acupoint implantation can significantly shorten the PHN pain relief time compared with western medicine.3.The incidence of adverse reactions is low.Only one study in the acupoint implantation group reported that two patients had subcutaneous swelling and bruising after suture implantation,and the symptoms disappeared without treatment after four days.Acupoint implantation is a safe and effective way to treat PHN.The clinical research results are as follows:1.Baseline data: A total of 68 patients were included in the study,and a total of 6cases were dropped.In the end,62 cases completed the trial.There was no statistical difference between the two groups of patients in terms of age,gender,course of disease,presence or absence of prodromal pain,and antiviral therapy in the acute phase(P>0.05).The baseline data of the two groups were comparable.2.The main outcome indicators are VAS score and efficacy evaluation.1)Comparison of VAS score: The baseline analysis of the two groups showed that the VAS scores before treatment were comparable(P>0.05).The VAS scores of the two groups showed a significant downward trend after the first and second courses of treatment.The difference in VAS scores between different groups was statistically significant(F=9.081,P=0.004),indicating that there were differences in VAS scores between groups;the differences in time and interaction were statistically significant(F=325.366,P=0.000;F=12.620,P=0.000).Compared with the pregabalin capsule group after treatment of D28 and D56,the floating needle embedding group has an advantage,and the difference is statistically significant(P<0.05).It shows that after treatment,the two groups have significantly improved the pain VAS score of the patients in the first and second courses of the treatment.(2)Comparison of curative effect: In the first course of treatment,compared between the two groups,the P<0.01,indicating that both groups have curative effects on PHN;the overall curative effect of the first course of the two groups is compared,Z=-1.546,and the P>0.05,indicating that the two groups are in the first course of treatment The difference in efficacy was not statistically significant.At the end of the second course of treatment(8W),The overall efficacy comparison,Z=-1.988,P<0.05.In the second course of treatment,the P<0.01,which was statistically significant.It shows that two groups are effective in PHN,and Absorbable Suture Floating Implantation has a higher effect.2.For the comparison of secondary indicators,the details are as follows.(1)PSQI analysis: The difference between the treatment and the control group before the formal treatment is not significant,and the P>0.05,so they are comparable.The score within the group before and after treatment is P<0.001,and the difference is significant.This means that these two groups can improve the patient's sleep quality.Comparison of PSQI difference before and after treatment,P<0.001,the difference is significant.It shows that in terms of improving sleep,the absorbable suture floating implantation treatment group has a better improvement effect than the oral medication group.(2)SDS analysis: For these two groups of patients before treatment,their scores on this index are basically the same(P<0.05).The two groups were compared within the group,and the difference was significant(P<0.001);It means that both groups can improve the patient's depressive state.SDS score difference before and after treatment was compared,P<0.001,the difference was significant.It shows that in terms of improving depression,the effect of the absorbable suture floating implantation group is better.(3)SAS analysis: For these two groups of patients,the difference before treatment is not statistically significant.The two groups were compared within the group,and the difference was significant(P<0.001);which means both groups can improve the patient's depressive state.Comparison of Difference of SAS scores before and after treatment,P<0.05,the difference is significant.It shows that in terms of improving anxiety,the effect of absorbable suture floating implantation is better.(4)Hematology test results(proportion of Treg and Th17 cells):The comparison of Treg and Th17 cell(%)indexes before treatment,P>0.05,are comparable.After treatment,the Treg and Th17(%)cells of the two groups were compared within the group,P<0.001,the difference was significant.It is suggested that both groups can reduce the levels of Treg and Th17 cells(%),and have an impact on the immunity of PHN patients.Comparison of blood Treg cell(%)difference before and after treatment showed no significant difference between the two groups(P=0.789>0.05),indicating that the effect of floating needle catgut embedding and oral pregabalin on improving blood Treg levels are equivalent.Comparison of the difference of serum Th17 cells before and after treatment,P<0.001,indicating that the absorbable suture floating implantation group is more effective in improving Th17 in PHN patients.It is considered that the floating needle embedding can play a better role in reducing the level of Th17 cells(%).Comparison of the difference of blood Treg cells before and after treatment showed no significant difference between the two groups(P=0.789>0.05),indicating that two groups are equivalent in improving blood Treg levels.Comparison of serum Th17 cells difference before and after treatment,P<0.001,indicating that the absorbable suture floating implantation group is more effect in Th17 cell in PHN patients.Considering absorbable suture floating implantation can reduce the level of Treg and Th17 cells.3.Safety analysis: For the treatment group,the proportion of adverse reactions in the treatment group by absorbable suture floating implantationis about 17.65%,which is much lower than the control group,which is 41.18%.The adverse reactions can be alleviated and returned to normal in a short time after simple treatment in the experiment group.The difference between the two is significant,the P<0.05.ConclusionMeta analysis results show that acupoint implantation is a safe and effective treatment method,which is more effective than the western medicine group in terms of improving patient pain,shortening the pain time,comprehensive curative effect and obvious efficiency.Clinical observations have found that Absorbable Suture Floating Implantation can quickly relieve the pain symptoms of PHN,and it can take effect within the first course of treatment,and the degree of pain relief is more obvious in the second course of treatment.In terms of improving pain,the two groups improved the cure rate,apparent efficiency,and effective rate compared with the first course of treatment.During the whole treatment process,while the Absorbable Suture Floating Implantation quickly relieves pain,it also improves the patient's quality of life,improves sleep,improves anxiety and depression,and maintains the patient's mental and emotional health.After treatment,the proportion of blood Treg and Th17 cells in PHN patients decreased,indicating that Treg and Th17 cells may be involved in the immune mechanism of PHN.Consider absorbable suture floating implantation by reducing the ratio of Treg cells and Th17 cells,improving immune function,and improving PHN symptoms.Therefore,absorbable suture floating implantation is a safe,effective,and simple method to treat PHN.Floating needle embedding can improve treatment efficiency and save time and cost.The operation time is short,once every 2 weeks,easy to adhere to,and significantly reduce the probability of adverse drug reactions,so that the safety of treatment has been significantly increased,and it is worthy of clinical application and promotion. |
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