Literature Analysis And Intervention Mechanism Study On Acupoint Application For The Treatment Of COPD In Remissio

Purpose:1.The clinical trails of acupoint application in the treatment of COPD in stable stage were systematically collected to evaluate its methodological quality and reporting quality,so as to provide reasonable suggestions for the design,implementation and reporting of clinical trails in the future.2.To carry out an overview of systematic review of acupoint application alone or in combination with other interventions in the treatment of COPD in remission stage,so as to provide the latest and comprehensive evidence-based proof for clinical decision-making.3.To summary the published literature of data mining in acupoint application,explore its advantages and disadvantages,and then combined with the characteristics of clinical research,use more rigorous,standardized and reasonable data mining methods to explore the acupoint selection rules and herbs using rules of acupoint application in the treatment of COPD in remission period,so as to provide reference for clinical practice.4.This clinical trial was designed by self-control to preliminarily explore the effect of Sanfu acupoint application on mi RNA in COPD patients in remission stage with lung and kidney qi deficiency syndrome,so as to provide new ideas for the research on the intervention mechanism of Sanfu acupoint application.Material and method:1.Literature quality evaluation of randomized controlled trials of acupoint application in the treatment of COPD in remission stageThe randomized controlled trial（RCT）for the treatment of COPD in stable stage were systematically searched in CNKI,Wanfang database,VIP database,Sinomed and Pubmed.The risk of bias assessment tool of Cochrane Collaboration Network and Consolidated Standards of Reporting Trials（CONSORT）2010 version were used to evaluate the methodological quality and reporting quality of the included RCTs.The literature screening and quality evaluation were carried out independently by two researchers,and the differences were decided through consultation or by a third senior researcher.2.An overview of systematic review of randomized controlled trial of acupoint application in the treatment of COPD in remission stageSystematic reviews of RCT of acupoint application in the treatment of COPD in remission stage were systematically retrieved in CNKI,Wanfang database,VIP database,Sinomed,Pubmed,Cochrane Library and Web of Science.Assessment of multiple systematic reviews-2（AMSTAR-2）,risk of bias in systematic reviews（ROBIS）,preferred reporting items for systematic reviews and meta-analyses（PRISMA）2020 version were used to evaluate methodological quality,risk of bias and reporting quality of the included systematic reviews.Grading of Recommendations Assessment,Development and Evaluation（GRADE）was used to rate the evidence included in the systematic reviews.For the meta-analysis results of each outcome,the binary data was be displayed with OR（odd ratio）or RR（relative risk）with 95% confidence interval,and the continuous data was displayed with WMD（weighted mean difference）or SMD（standard mean difference）with 95% confidence interval.Literature screening,data extraction,quality evaluation and evidence rating were carried out independently by two researchers,and differences were decided through consultation or by a third senior researcher.3.Study on selection rules of acupoint and Chinese medicine in acupoint application in the treatment of COPD in remission stage based on data miningData mining literature of acupoint application in the treatment of COPD in remission stage were systematically retrieved in CNKI,Wanfang database,VIP database,Sinomed and Pubmed.The implementation process and research results of the included literature were extracted and summarized according to the data extraction form formulated in advance.On this foundation,RCTs of acupoint application for the treatment COPD in remission stage were systematically searched in CNKI,Wanfang database,VIP database,Sinomed and Pubmed.The risk of bias assessment tool of Cochrane Collaboration Network was used to evaluate the risk of bias of RCTs,and Excel 2010 was used to perform frequency analysis for Chinese medicine and acupoint selections in RCTs.4.Study on the intervention mechanism of Sanfu acupoint application in the treatment of COPD patients in remission stage with lung and kidney qi deficiency syndrome based on mi RNACOPD patients in remission with lung and kidney qi deficiency syndrome were recruited in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.The patients were intervened by Sanfu acupoint application for 1 year.Blood samples of the patients were collected before and after the intervention and conducted high-throughput sequencing.mi RNAs differentially expressed were analyzed before and after the intervention,and further GO（Gene Ontology）and KEGG（Kyoto Encyclopedia of Genes and Genomes）enrichment analysis were performed.Results:1.Literature quality evaluation of randomized controlled trials of acupoint application in the treatment of COPD in remission stageThrough searching and screening,148 RCTs were finally included.The risk of bias assessment results showed that the overall methodological quality is not high,and its main problems were unclear or not reporting in the generation of random sequence,the concealment of random sequence and the use of blind method.In addition,some studies did not report clearly on the integrity of the outcome.The overall reporting quality of the RCTs included were not high,and it needs to be further improved in terms of title expression,specific purpose or hypothesis description in introduction,implementation method of RCT design,statistics and display form of outcome,discussion and other information such as trail registration,trail protocol and funding,etc.The reports of acupoint application intervention measures needs to be further improved in terms of the rationality of application selection,the proportion or dosage of Chinese medicine,specific operation,precautions,potential adverse reactions and solutions.2.An overview of systematic review of randomized controlled trial of acupoint application in the treatment of COPD in stable stageThrough systematic retrieval and screening,11 systematic reviews meeting the standards were finally determined,which involving 131 RCTs.The methodological quality,risk of bias and reporting quality of the 11 systematic reviews need to be further strengthened.The reasons for the reduce of methodological quality mainly include the formulation and registration of trail protocol,integrity of retrieval strategy,provision of literature exclusion list and reasons,the source of original research funds,meta-analysis considering risk of bias of original research,funding and conflict of interest.The reasons for high risk of bias mainly include the description of inclusion criteria,retrieval and screening in research,data extraction and quality evaluation,data synthesis and result presentation,as well as the overall risk of bias.The main reasons for reduction of reporting quality mainly include structural summary,retrieval strategy,processing method of information loss,definition of outcome,data synthesis methodology,result presentation,registration and conflict of interest,etc.A total of 94 evidence were obtained from 11 systematic reviews,including 6 high level,31 middle level,39 low level and 18 very low level quality evidences.3.Study on selection rules of acupoint and Chinese medicine in acupoint application in the treatment of COPD in remission stage based on data miningThrough systematic retrieval and screening,7 data mining documents meeting the standards were finally determined.It was founded that comprehensiveness of the original research retrieval,rationality of combined analysis of data,diagnostic criteria of cases,transparency of the production process,selection of data analysis methods and the objectivity of discussion need to be further improved.Through systematic search,138 RCTs of acupoint application in the treatment of COPD in remission stage were finally determined,but the overall methodological quality were not high.The results showed that Chinese medicine commonly used in acupoint application includes semen brassicae,euphorbia kansui,asarum and corydalis tuber.For the selection of acupoints,the acupoints often selected in "Sanfu application" include feishu,shenshu,dingchuan,pishu,tiantu,dazhui,etc.The acupoints commonly selected in "routine acupoint application" include feishu,dazhui,tiantu,shenshu,tanzhong,dingchuan,pishu,etc;The acupoints commonly used in "Fujiu acupoint application" include feishu,tiantu,dingchuan,tanzhong,shenshu,pishu,etc.4.Study on the intervention mechanism of Sanfu acupoint application in the treatment of COPD patients in remission stage with lung and kidney qi deficiency syndrome based on mi RNAIn this study,12 COPD patients in remission stage with lung and kidney qi deficiency syndrome were recruited,in which of 7 cases completed the intervention of Sanfu acupoint application.A total of 90 significantly differentially expressed mi RNAs were detected through high-throughput sequencing of 19 blood samples collected before and after the intervention.Compared with that before the intervention,26 kinds of mi RNAs were significantly up expressed after intervention,The difference of hsa-mi R-491-5p_L-2R+2,hsa-mi R-1304-3p₁ss13CA and mmr-mi R-1839 were the most significant;64 kinds of mi RNAs were down regulated after intervention,The difference of bta-mi R-378_L-1R+1₁ss10GT and hsa-mi R-193a-3p_R-2 were the most significant.Based on the results of GO enrichment analysis,the molecular function mainly include protein binding,metal ion binding and transferase activity,etc;the cellular component mainly include cytoplasm,cytosol and nucleus,etc;the biological process mainly include positive regulation of transcription by RNA polymerase II,regulation of transcription,DNA-templated and multicellular organism development,etc.Based on the results of KEGG enrichment analysism,the enrichment pathways mainly include pathways in cancer,Rap1 signaling pathway and PI3K-Akt signaling pathway,etc.Conclusion:1.The overall reporting quality of acupoint application in the treatment of COPD in remission stage is not high.Before implementation,it is necessary to carry out scientific,rigorous and feasible trial design,register on the clinical trial registration platform,and report based on the relevant statements of CONSORT.In addition,the reporting items related to acupoint application needs to be formulated and popularized in order to facilitate the standardization.2.The methodological quality and reporting quality of systematic reviews of acupoint application in the treatment of COPD in remission stage need to be further improved.It is recommended to refer to AMSTAR-2 and ROBIS list and report strictly in accordance with PRISMA 2020.In addition,reporting items of overview of systematic review is urgently need to be formulated and published in order to standardize the production and reporting.3.The authenticity of the research,reliability of the results and comprehensiveness of the report need to be further strengthened in production,implementation and report in data mining research on topics related to acupoint application.The effectiveness and safety of acupoint application in the treatment of COPD in remission stage need to be verified by RCTs with rigorous design,standardized implementation,large sample and high-quality in future.4.Sanfu acupoint application can affect the mi RNA expression of COPD patients in remission stage with lung and kidney qi deficiency syndrome at the transcriptome level,and then play a therapeutic role.The subsequent research for results need to be verified and further explored.