Clinical Efficacy And Mechanism Of Acupuncture In The Treatment Of Perennial Allergic Rhiniti

Background:Allergic Rhinitis(AR)is a non infectious chronic inflammatory disease of the nasal mucosa.In recent years,the incidence has gradually increased,causing a significant burden on patients and families,especially perennial allergic rhinitis(PAR).PAR is caused by the deficiency of the lungs,spleen,and kidneys,insufficient vital energy,and weak external defense.Although the onset site is in the nose,the root cause of the disease lies in the overall imbalance of internal organs and health.Therefore,treatment should aim at overall regulation and treatment of both symptoms and symptoms.Currently,many studies have confirmed the effectiveness of acupuncture in treating PAR,but further exploration is needed on how to treat PAR from the perspective of internal overall imbalance and ensure the durability of the therapeutic effect.The current research on the mechanism of acupuncture treatment for AR mainly explores the improvement of local immune response,but there is a lack of research on the overall neural immune regulatory mechanism.Therefore,further research is needed on the clinical and mechanism of acupuncture treatment of PAR from a holistic perspective.Objective:Using a randomized controlled trial method,this study compared and analyzed the effects of two treatment plans,overall acupoint selection acupuncture and local acupoint selection acupuncture,on the clinical symptoms and quality of life of PAR patients,and explored the efficacy and advantages of overall acupoint selection acupuncture treatment for PAR.By conducting acupuncture intervention on AR rats,the changes in immune factors,hormone levels,and degree of nasal mucosal lesions related to the hypothalamic pituitary adrenal(HPA)axis were observed before and after the intervention,and the correlation between acupuncture treatment of AR and HPA axis was explored.Methods:Study 1:Clinical study on acupuncture treatment of perennial allergic rhinitis:a randomized controlled trial.This study used a randomized controlled trial method,using a random number table,to randomly divide the included PAR patients into an experimental group and a control group in a 1:1 ratio.Both groups received acupuncture treatment.The experimental group adopted a holistic acupoint selection and acupuncture scheme,with acupoints selected from Dazhui,Feishu,Zusanli,and Hegu.The prone position was first selected,and the Dazhui and Feishu acupoints were acupuncture.After obtaining qi,the ping bu ping xie technique was applied for 30 seconds,and the needle was left for 20 minutes;Take the supine position again,acupuncture at Zusanli and Hegu.After obtaining qi,apply the technique of leveling,tonifying,and reducing for 30 seconds,and leave the needle for 20 minutes.The control group adopted a local acupoint selection and acupuncture scheme,with acupoints selected as Yingxiang and Yintang.They were placed in a supine position for acupuncture,and after obtaining qi,they were treated with a calming,tonifying,and reducing technique for 30 seconds.The needles were left for 20 minutes before being released.Both groups received acupuncture treatment every other day for 4 consecutive weeks.This study used the Rhinoconjunctivities Quality of Life Questionnaire(RQLQ)for patients with nasal conjunctivitis as the primary efficacy indicator,while the Total Nasal Symptom score(TNSS)and Total Non Nasal Symptom score(TNNSS)were secondary efficacy indicators.The subjects received weekly evaluations on the day of enrollment and from week 1 to week 4 after enrollment,followed up for 2 months,and received evaluations every month.Record adverse events of patients during the study period.Study 2:Study on the Mechanism of Acupuncture Relieving Allergic Rhinitis Mediated by HPA Axis.Randomly divide rats into five groups:blank control group,model control group,acupuncture group,acupuncture+RU486(mifepristone)group,and RU486 group.The blank control group did not intervene and did not establish an AR model.The other groups established an AR rat model using egg albumin nasal drip method.After establishing an AR rat model,each group received continuous nasal drip of albumin,acupuncture,RU486+acupuncture,and RU486 intervention for 14 consecutive days.After the intervention,behavioral scores were performed on AR rats in each group.After the rats were euthanized,peripheral blood,nasal mucosa,and brain tissue samples were collected.ELISA was used to detect IL-4,IL-5,IL-13,and IFN in peripheral blood-γ、CORT,CRH,and ACTH content,HE staining of nasal mucosa,immunofluorescence staining of brain tissue,and analysis.Results:Study 1:Clinical study on acupuncture treatment of perennial allergic rhinitis:a randomized controlled trial.1.Population baseline dataA total of 59 subjects(31 males and 28 females)were included in the study and randomly divided into an experimental group of 29 cases(15 males and 14 females)and a control group of 30 cases(16 males and 14 females);The age of the experimental group was 30.06±6.32 years old,while the age of the control group was 28.30 ± 6.57 years old;The course of disease in the experimental group was 6.00(4.00-8.75)years,while in the control group it was 5.50(3.75-9.75)years.There was no statistically significant difference in gender,age,and course between the two groups(P>0.05).2 Efficacy evaluation indicatorsBaseline period:The RQLQ scores of the two groups were 66.50(39.25-79.75)in the experimental group and 71.50(65.75-75.00)in the control group,respectively;The TNSS scores were 10.00(9.75-11.75)for the experimental group and 10.00(9.75-12.00)for the control group,respectively;The TNNSS scores were 4.50(3.75-5.00)for the experimental group and 3.00(2.00-4.00)for the control group,respectively.After testing,there was no statistically significant difference in the baseline scores of the three efficacy indicators between the groups(P>0.05).Treatment period:There was no statistically significant difference in RQLQ scores between the two groups at different time points(P>0.05);In the two groups of TNSS scores at various time points,the second evaluation score of the experimental group during the treatment period was 8.50(7.00-10.00)higher than that of the control group(5.00(3.75-8.25),with a statistically significant difference(P<0.05).The third evaluation score of the experimental group during the treatment period was 7.50(6.00-8.75)higher than that of the control group(5.50(2.75-7.25),with a statistically significant difference(P<0.05);There was no statistically significant difference in TNNSS scores between the two groups at different time points(P>0.05).Follow up period:Analysis of RQLQ scores at various time points showed that the second evaluation score of the experimental group during the follow-up period was 23.00(17.00～29.00)lower than the control group’s 37.00(30.50～39.50),with a statistically significant difference(P<0.05);There was no statistically significant difference in TNSS scores between the two groups at different time points(P>0.05);In the TNNSS scores at various time points,the second evaluation score of 2.00(1.00～2.00)in the experimental group during the follow-up period was lower than that of 2.50(2.00～3.00)in the control group,with a statistically significant difference(P<0.05).3 RQLQ sub scoresThere was no statistically significant difference in the sub indicators of RQLQ between the two groups during the baseline period(P>0.05).In the fourth score during the treatment period,there was a statistically significant difference(P<0.05)in the sub scores of sleep,nasal symptoms,eye symptoms,and emotions between the two groups.The experimental group was lower in the sub scores of sleep and emotion than the control group,while the control group was lower in the sub scores of nasal symptoms and eye symptoms than the experimental group.Study 2:Study on the Mechanism of Acupuncture Relieving Allergic Rhinitis Mediated by HPA Axis.1 Behavioral RatingThe behavioral scores of rats in each AR group at the end of the intervention period were higher than those in the blank control group,and the difference was statistically significant(P<0.05).The score of the acupuncture group was lower than that of the model control group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).2.HE staining results of nasal mucosa tissueAfter the intervention,nasal mucosa samples were taken from blank control group,model control group,acupuncture group,acupuncture+RU486 group,and RU486 group rats.No abnormalities were found in the nasal mucosa of all rats(8/8)in the blank control group.In the model control group,87.5%of the rats(7/8)had obvious pathological changes such as cilia lodging,edema,goblet cell hypertrophy,and vascular dilatation.75%of the rats in the acupuncture group(6/8)had significantly reduced pathological changes under nasal mucosa endoscopy compared to the model control group.The pathological changes of 37.5%of rats(3/8)in the acupuncture+RU486 group under nasal mucosa endoscopy were alleviated compared to the model control group and RU486 group.The nasal mucosa of all rats in the RU486 group(8/8)was similar to the model control group,with obvious pathological changes visible.Comparison of serum immune factors and hormone levelsThe serum IL-4 levels of rats in each AR group were higher than those in the blank control group,and the differences were statistically significant(P<0.05).The serum IL-4 content in the acupuncture group was lower than that in the model control group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).The serum IL-5 levels of rats in each AR group were higher than those in the blank control group,and the differences were statistically significant(P<0.05).There was a statistically significant difference in serum IL-5 content among the AR groups(P<0.05),with the acupuncture group having the lowest content.The serum IL-13 levels of rats in each AR group were higher than those in the blank control group,and the differences were statistically significant(P<0.05).The serum IL-13 content in the acupuncture group was lower than that in the model control group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).The serum IL-13 content in the model control group was higher than that in the acupuncture+RU486 group and RU486 group,with statistical significance(P<0.05).Serum IFN of rats in each AR group-γ Both were lower than the blank control group,and the differences were statistically significant(P<0.05).Serum IFN between AR groupsy The difference in content was statistically significant(P<0.05),with the acupuncture group having serum IFN-y The highest.The serum CORT content of rats in each AR group was higher than that of the blank control group,and the differences were statistically significant(P<0.05).The serum CORT content in the acupuncture group was lower than that in the model control group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).The serum CORT content in the model control group was higher than that in the acupuncture+RU486 group and RU486 group,with statistical significance(P<0.05).The serum CRH content of rats in each AR group was higher than that of the blank control group,and the differences were statistically significant(P<0.05).The serum CRH content in the model control group was higher than that in the acupuncture group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).The serum CRH levels in the acupuncture+RU486 group and acupuncture group were higher than those in the RU486 group,and the differences were statistically significant(P<0.05).The serum ACTH content of rats in each AR group was higher than that of the blank control group,and the differences were statistically significant(P<0.05).The serum ACTH content in the acupuncture group was lower than that in the model control group,acupuncture+RU486 group,and RU486 group,with statistical significance(P<0.05).Conclusion:Both overall and local acupoint selection acupuncture have good therapeutic effects on PAR.Overall acupoint selection acupuncture has better efficacy in improving nasal accompanying symptoms,emotional disorders,sleep disorders,and quality of life in PAR patients,and the therapeutic effect is maintained for a longer time;Local acupoint selection and acupuncture have a better therapeutic effect on improving nasal symptoms in patients.Acupuncture can effectively improve the behavioral scores of AR rats,regulate serum inflammatory factor levels,improve Thl/Th2 balance,and regulate HPA axis related hormone levels.Acupuncture is effective in treating AR,and the therapeutic mechanism is related to the regulation of HPA axis function.