| This paper is research for many years on the basis of the clinical research of acupuncture and moxibustion treatment of allergic rhinitis.Allergic rhinitis,also known as allergic rhinitis,rhinitis,variability is mainly composed of atopic system of individual after exposure to an allergen mediated by IgE medium(mainly for histamine)release,and there are a number of immunocompetent cells and cytokines involved in nasal mucosa disease non-infectious chronic inflammatory response,is one of the common chronic disease of clinical.Its main clinical feature is:sneezing,nasal hypersecretion,stuffy nose,nasal itching and swelling of the nasal mucosa.The disease clinically consists of perennial allergic rhinitis and seasonal allergic rhinitis,the latter are often referred to as "hay fever".AR is not a serious clinical disease,but often seriously affected People's Daily life,study and work efficiency;Especially children,to their physical and mental health,study result caused certain negative influence,caused a certain economic burden to family.Related research reports,more than a decade the number of cases of the disease is increasing year by year,the world is about 12%~25%of the people.The current treatment methods are mainly composed of drugs.Clinical common western medicine mainly include cortical hormone,antihistamines,leukotriene receptor antagonist,decongestants,and mast cell membrane stabilizer,etc.And traditional Chinese medicine in the treatment of this disease also accumulated a lot of experience,traditional Chinese medicine thinks:the lung main fur,begin to understand in the nose,invaded by infringement of fur,lung xuan drop loss function is characterized by fluid distribution obstacles,fluid congestion,nasal orifices impassability and stuff,this is the call of "allergic rhinitis":And the allergic disease itself by to mostly ferrite,when lung qi deficiency,who is not solid,cold often decide invasion,illness is used over and over again.Treatment to make up for the lung functions of cold is given priority to,and comply with acupuncture and moxibustion treatment,to justify find,eliminate pathogenic centralizer,in order to obtain good effect,acupuncture and moxibustion treatment of allergic rhinitis often is internal and external causes homology,mainly selected head facial local as well as the lung,large intestine via acupoint primarily;At the same time as the "xuan lung:" match with yangming meridian or back shenshu point to "yiqi thrift".Objective:Based on the previous clinical studies,on the basis of this research mainly through the literature of acupuncture and moxibustion treatment of allergic rhinitis patients system evaluation and Meta analysis,explicit exact curative effect of acupuncture in the treatment of the disease process and effective method,in order to further guide clinical practice and research provides the basis for the mechanism of action of acupuncture and moxibustion for the disease.Methods:(1)Retrieval by computer literature database retrieval,including PubMed,Embase,the Cochrane library,China academic journal full-text database(CNKI),Chinese journal full-text database(VIP)of science and technology,the Chinese biomedical literature database(CBM),database,and has set language restrictions of literature retrieval,retrieval of fixed number of year for the database default starting fixed number of year of the relevant literature.Retrieval method is given priority to the combination of the inscription and free word retrieval strategy:Chinese word retrieval:perennial rhinitis,allergic rhinitis,allergic rhinitis,hay fever,acupuncture,acupuncture,moxibustion and cupping,acupuncture,etc;The key words in English:rhinitis,allergic rhinitis,perennial allergic rhinitis,pollinosis,acupuncture and moxibustion,electric acupuncture,needling,acupoint,etc.In the retrieved literature after the prescribed conditions,the trace into the literature after the relevant references,as much as possible into the comprehensive research,reduce the possibility of residual;Will import the retrieved literature Noteexpress data management software,after rechecking again ruled out,in turn,the abstract is not in conformity with the cases,the final choice literature line system evaluation are analyzed.(2)Inclusion criteria:select currently published about acupuncture in the treatment of allergic rhinitis is given priority to with clinical in a random Controlled study,design documents(Randomized Controlled Trials,RCT),can contain blind and non-blind method research plan;And to observe the efficacy and safety of main purpose;(2)patients with clinical symptoms of allergic rhinitis,gender,cases sources,types,unlimited duration;(3)the object of study of 18 one full year of life,should be greater than the control group and observation group of patients with baseline data should have good balance,comparable,and the first diagnosis should are the disease,should have a clear diagnostic criteria and exclusion criteria;(4)the observation group with acupuncture treatment method,parallel positive control group treated with conventional western medicine or accepted western medicine treatment;(5)should be reported in the literature to observe group and the control group,two groups of the total number of cases of outcome indicators should be recovered,powerfully,effective and invalid evaluation evaluation method.(3)Exclusion criteria:(1)the object of study mainly focuses on the clinical adverse reactions report for animals,and give priority to with drug research of pharmacology,pharmacokinetic and clinical curative effect evaluation research of related literature;(2)not published in curative effect evaluation and(or)statistical analysis of the results of the treatment methods are not clear clinical trials;(3)randomized controlled scheme not clear clinical trials;(4)the patient's own comparison before and after cl.inical research;(5)simple description of the research;(6)Wen Xianxing reviews,clinical case reports and related clinical expert personal experience reports;(7)with other diseases;(8)of traditional Chinese medicine acupuncture and other external treatment of traditional Chinese medicine treatment compared the clinical efficacy of research.(4)Method of literature evaluation:all the documents that are attached to the system evaluation respectively independently by two researchers in related professional tutors,the related literature clearly does not meet the inclusion criteria were reviewed,in this paper,through reading literature,likely to fit into the standard documents,carefully read the full text,to determine whether a real meet eligibility criteria,and evaluators to separate each into the standard quality of literature evaluation and related data extraction treatment,and cross check,don't agree,then from the analysis of two people together to discuss,to ensure our agreement,if necessary by the third researchers to solve or to another related expert consultation to solve.To conform to the inclusion criteria of literature quality reference Conchrane H and book5.0.2 version is recommended to use bias risk assessment tools in combination with the evidence-based acupuncture clinical practice guidelines,RCT quality evaluation of literature quality evaluation:0:not described or improper implementation and random methods described or double blind method;Or did not describe the removal or termination of the subjects and the number of reasons.Method 1:describes the application of random or double blind method;Describes the removal or termination of a crowd of number and reason.Two points:the correct use and describes the application of appropriate methods of random or double blind method;Or correct use of single blinded clinical research literature,data statistics and curative effect of evaluators blind).Total score of 5 points,A level 3 or higher,B = 2,C grade 1 minute or less.(5)Statistical analysis:application provided by the Cochrane Review Manager 5.0 software for data processing.Before Meta statistical analysis,all included in the study of heterogeneity of data using 2 and P values for inspection,and 12 evaluate the size of the heterogeneity.No statistical heterogeneity,by using the fixed effects model(P 0.1 or higher,12 50%or less);If there are statistical heterogeneity(P<0.1,12>50%),the analysis of causes of heterogeneity in the random effects model,when heterogeneity is too large,only descriptive statistics analysis;Count data with odds ratio(OR)and 95%confidence interval,said the measurement data with weighted mean difference and 95%confidence interval;Finally,to pour into the literature funnel chart analysis,analysis of literature the presence of publication bias.Results:(1)Literature search results related paper checked out at the beginning of 351,eliminate duplicate documents,according to include and exclude standards,eventually into 28 randomized controlled trials;Which Chinese with 26 references(4 degree dissertations,journal articles 22),English 2 references,including A level 3 references,class B with 8 references,classC with 17 references.(2)Total effective rate is in accord with conditions of 28 23 in clinical research articles on the research analysis,the total effective rate in this study for 23 articles with efficient statistical heterogeneity analysis,the results suggest:P = 0.35,I2 = 8%,the results showed that in analyzing into 23 articles that are statistically homogeneous,by using the fixed effects model analysis results show that the OR = 3.47,95%CI:2.83~4.26,Z = 2.83(P<0.00001),can be thought of acupuncture and moxibustion has a statistically significant difference between the treatment group and control group.(3)Recurrence rate is in accord with conditions of 28 five articles in clinical research to study the total recurrence rate were analyzed,and the research to have the recurrence rate statistical heterogeneity analysis,five documents results suggest:P = 0.65,12 = 0%,by using the fixed effects model analysis results show that the OR = 0.06,95%CI:0.02~0.17,Z = 0.02(P<0.00001),can be thought of acupuncture and moxibustion has a statistically significant difference between the treatment group and control group.(4)Secretion of eosinophils(EOS)content changes into 28 study,only 5 study compared the EOS content change after treatment.Acupuncture and the control group after the treatment of allergic rhinitis EOS content change of Meta analysis,the five research has homogeneity(P = 0.83,I2 = 0%),the results show that the secretion of eosinophils reduced index of SMD = 0.68,95%CI:0.91~0.44,the overall effect inspection Z = 5.60(P<0.00001),suggesting that the comparison between the two groups have statistical significance.(5)28 study,clinical symptom scores into nine study describes the improvement of clinical symptoms before and after the treatment,the Meta analysis,9 no heterogeneity study(I2 = 50%),use the random effects model combined analysis;And 9 institute with symptoms rating scale is not unified,the SMD effect index analysis is adopted.SMD = 1.18,95%CI:1.37~0.99,the overall effect inspection Z = 12.13(P<0.00001),suggesting that the comparison between the two groups have statistical significance.(6)Serum IgE levels change situation in 28 study,there are 7 study compared the changes in serum IgE levels after treatment,the changes between the two groups of Meta analysis,the seven study has homogeneity(P = 0.26,I2 = 22%),by the fixed effect model to carry on the analysis,serum IgE lower index of SMD = 0.57 remarks%,CI:0.76~0.38,the overall effect inspection Z = 5),83(P<0.00001),suggesting that the comparison between the two groups have statistical significance.Conclusion:Acupuncture in the treatment of allergic rhinitis has a certain advantage,pure acupuncture treatment compared with pure drugs or other treatments can improve efficiency and reduce the recurrence rate,and acupuncture can significantly improve the patient's clinical symptoms,reduce the number of EOS,reduce serum total IgE in the drug has obvious advantage.In this study included 28 articles were concluded that emphasize the positive,this may be one of the causes of publication bias;In addition,randomized,double-blind trial no evaluation,no late follow-up studies;Also,the safety of acupuncture therapy reported also seldom reported.Therefore,in the future the clinical research of the disease,should pay attention to the quality of literature evaluation,should be mainly through high quality clinical research such as multicenter,large sample,standardization of clinical randomized controlled trials of system analysis,so as to further provides a reliable clinical evidence for acupuncture treatment of the disease of these conclusions obtained can be reference for clinical doctors in clinical practice,also can be used to provide the basis of the further study. |
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