Systematic Evaluation And Meta-analysis Of Acupuncture For Psoriasis Vulgaris

Objective:To determine the efficiency and safety of acupuncture and moxibustion for psoriasis vulgaris.Methods:1.Search methods:We've searched the CNKI, CBM, Pubmed, CENTRAL, Embase, and also searched the important journals of TCM. The articles were searched by two reviewers independently and all the work had been finished before February 2015.2.Including and excluding criteria:We've collected the randomized controlled trials which could meet to the diagnostic criteria of psoriasis vulgaris. The trials which compared acupuncture and moxibustion with western medicine,placebo,sham acupuncture therapy or other treatment were included. But the trials which compared acupuncture and moxibustion with different acupuncture methods,Chinese herbal medicine,the trials combined with other treatments,or clinical randomized trials were excluded.3.Data collection and analysis:The data was collected by two reviewers independently. Then,with the RevMan 5.3.0, so we could assess the risk of bias and analyze the data. With GRADE profiler3.6.1, we could evaluate the evidence grade.Main results:1.Search results:13 studies had been included, while 499 trials excluded. They recruited 1293 patients who had been suffered from psoriasis vulgaris, aged from 18 to 65 years.647 patients had been treated with acupuncture and moxibustion,while the other 646 patients had been treated with other therapy.2.Analysis results:2.1 Meta-analysis results:(1)Acupuncture and moxibustion therapy VS Western Medicine therapy:Clinical efficiency (RR 1.14,95%CI 1.08 to 1.21), low. PASI [SMD0.29 lower(0.41 to 0.18 lower),low.(2)Micropuncture therapy VS Western Medicine therapy:Clinical efficiency (RR 1.1,95%CI 1.01 to 1.21), very low. PASI [SMD 0.21 lower (0.39 to 0.03 lower)], very low.(3)Fire-needle therapy VS Western Medicine therapy:Clinical efficiency (RR 1.13,95%CI 1.02 to 1.26),very low. PASI [SMD 0.30 lower(0.56 to 0.04 lower)], very low.(4)Electro-acupuncture therapy VS Western Medicine therapy:Clinical efficiency (RR1.13,95%CI 1.02 to 1.26), low. PASI [SMD 0.35 lower(0.64 to 0.06 lower)], low.(5)Acupuncture and moxibustion therapy VS Western Medicine therapy:Side effects(OR 0.09,95%CI 0.04 to 0.20), high.2.2 Qualitative analysis(1) Acupoint injection therapy VS Western Medicine therapy:Clinical efficiency (RR1.20,95%CI 1.03 to 1.39), low. PASI [SMD 0.30 lower(0.58 to 0.02 lower)], low.(2) Micropuncture+Electro-acupuncture therapy VS Western Medicine therapy: Clinical efficiency (RR1.40,95%CI 1.04 to 1.89),very low. PASI [SMD 0.61 lower(1.21 to 0.01 lower)], very low. Npt score[SMD 1.43 lower (2.09 to 0.77 lower)], very low.(3) Acupuncture+cutaneous needle+cotton moxibustion VS Western Medicine therapy:Clinical efficiency (RR1.29,95%CI 1.01 to 1.65),very low. PASI [SMD 0.48 lower(0.93 to 0.03 lower)], very low. DLQI [SMD 0.53 lower (0.98 to 0.08 lower)], very low.(4) Fire-needle VS Western Medicine therapy:Pruritus score [SMD0.62 lower( 1.13 to 0.11 lower)], very low.(5)Electro-acupuncture therapy VS Placebo acupuncture:Clinical efficiency (RR 0.89,95%CI 0.60 to1.32),very low.PASI[SMD 0.47 higher (0.06 lower to 1.01 high-er)] very low.Conclusions:1. Acupuncture and moxibustion therapy is superior to the western medicine in reducing PASI and improving clinical efficacy rates. But the qualities of the evidence grades are low. Therefore, the conclusion should be treated with caution.2.Mircopuncture is better than the western medicine therapy in reducing the PASI score and improving efficacy rates. But the qualities of the evidence grades are very low. Therefore, the conclusion should be treated with caution.3.Fire-needle is better than the western medicine therapy in reducing the PASI score, improving clinical efficacy rates and reducing the symptom of pruritus. But the qualities of the evidence grades are low,low and very low.Therefore,the conclusion should be treated with caution.4.Electro-acupuncture, acupoint injection are better than the western medicine therapy in reducing PASI score and improving efficacy rates. But the qualities of the evidence grades are low. Therefore, the conclusion should be treated with caution.5.Micropuncture together with electro-acupuncture has apparent advantages compared with western medicine therapy in reducing PASI and Npt score, improving clinical efficacy rates. But the qualities of the evidence grades are very low.Therefore, the conclusion should be treated with caution.6.Acupuncture+cutaneous needle+cotton moxibustion has apparent advantages compared with western medicine therapy in reducing PASI, DLQI score, improving clinical efficacy rates. But the qualities of the evidence grades are very low.Therefore, the conclusion should be treated with caution.7.Electro-acupuncture doesn't have any advantages compared with the western medicine therapy in improving the clinical efficacy rates and reducing PASI score. But the quality of the evidence grades are very low. Therefore, the conclusion should be treated with caution.8.Acupuncture and moxibustion therapy have got lower side effects than the western medicine therapy, and the quality of the evidence grade is high. Therefore, the conclusion is sound believable.