| Objective1.Meta-analysis was used to evaluate the efficacy of acupuncture treatment on chemotherapy-induced peripheral neuropathy(CIPN)in improving the quality of life,nerve conduction velocity and nerve amplitude of patients;2.Summarized and sorted out the commonly used acupoints,and analyzed the acupoint selection rules,so as to provide references for subsequent basice research and clinical practice;3.To analyze the deficiencies of clinical trials on acupuncture treatment of chemotherapy induced peripheral neuropathy,and to provide methodological basis for clinical trials on acupuncture and moxibustion.MethodsTo formulate the literature inclusion criteria and establish the searching?strategy.Electronic retrieval of the China National Knowledge Infrastructure(CNKI),Wanfang database,the Chinese biomedical literature database(CBM),VIP database(VIP),PubMed,Embase(via OvidSP),the Cochrane Library.Manual searching the literatures of clinical randomized trial research about acupuncture treatment on CIPN in the Library of Guangzhou university of Chinese medicine,deadline 2018.12.31.Eliminate duplicate documents,according to literature inclusion criteria,determine incorporated in the literature.A Meta-analysis of the included literatures was performed using the Cochrane systematic evaluation method by ReviewManagers5.3 software.Resu tsA total of 19 literatures were included.The included literatures had insufficient awareness of concealed grouping(allocation of concealment)in clinical trial design,and were often confused with the concept of blind method,with inconsistent baselines and poor methodological quality.A total of 1108 patients were included in this study,including 525 in the experimental group and 553 in the control group.The experimental group used acupuncture(including manual acupuncture,electroacupuncture and needle warming moxibustion),and the control group used other treatment methods(including blank control group,intramuscular injection of mecobalamine,vitamin B group and adenosine cobalamin).Extracting the data of total effective rate,the median nerve sensory and motor nerve conduction velocity,sural total sensory and motor nerve conduction velocity,ulnar nerve sensory and motor nerve conduction velocity,sural nerve sensory nerrre conduction velocity,sural nerve conduction amplitude and median nerve conduction,Karnofsky scale,digital pain rating scale,FACT-NTX rating scale,and the subgroup analyzed the effectiveness of acupuncture VS adenosine cobalt amine,the effectiveness of acupuncture VS intramuscular injection B vitamins,acupuncture VS a cobalt amine efficiently.Meta-analysis showed that in terms of total treatment rate,the treatment group(RR=1.52,95%CI[1.36,1.70],P<0.00001)and in terms of subgroup analysis,RR acupuncture vs.adenosine cobalamin=1.45,95%CI[1.13,1.88],P=0.004.RR acupuncture VS intramuscular injection of B vitamins 1.84,95%CI[1.41,2.39],P<0.00001,RR acupuncture VS mecobalamin=1.95,95%CI[1.34,2.86],P=0.0005).In terms of improving sensory nerve conduction velocity,MD sural nerve=3.20,95%CI[2.95,3.46],P<0.00001,MD ulnar nerve =6.14,95%CI[3.82,8.47],P<0.00001,the experimental group was superior to the control group.The sensory nerve conduction velocity of median nerve and common peroneal nerve was not meta-analyzed due to the high heterogeneity of the studies.In terms of motor nerve conduction velocity,MD median nerve=0.40,95%CI[-0.80,1.61],P=0.51,MD common peroneal nerve=-0.89,95%CI[-1.17,2.19],P=0.08.There was no statistical difference between the experimental group and the control group in improving the motor nerve conduction velocity of median nerve and common peroneal nerve.In terms of nerve conduction amplitude,MD sural nerve=2.57,95%CI[0.82,4.32],P=0.004,that is,the experimental group was superior to the control group in improving the conduction amplitude of sural nerve.The median nerve conduction amplitude was not statistically significant(MD median nerve=2.47,95%CI[-0.27,7.00],P=0.29).In terms of scoring scale,MD Karnofsky scale=4.13,95%CI[2.79,5.48],P<0.00001,suggesting that the experimental group is superior to the control group in improving Carlisle score.In FACT,the comparison between the two groups indicated no statistical difference(MDFACT-ntx=-1.69,95%CI[-3.67,0.29],P=0.09).Due to the large heterogeneity of the studies included in the digital pain assessment scale,no Meta-analysis was performed.Will the study into the GRADE evaluation comparison of statistical significance,it is concluded that acupuncture treatment of chemotherapy induced peripheral neuropathy in the total effective rate,Karnofsky scale score,sural nerve,ulnar nerve sensory nerve conduction velocity amplitude have recommended "moderate",in the aspect of sural nerve conduction velocity get the recommended "very low".Conclusion1.Acupuncture and moxibustion prevention and treatment of CIPN.Yangming meridian is the main acupoint selected,and the commonly used acupoints are Zusanli(ST36),Hegu(LI4),Taichong(LR3),Quchi(LI11)and Yanglingquan(GB34).Also,choose the local acupoint according to the location of diseased region.2.CIPN is a kind of lesion subjectively felt by patients.In terms of subjective indicators,experimental group is superior to the control group in total effective rate and Karnofsky scale score,and GRADE is recommended as "moderate".Other subjective indexes need strict and standard experimental design to prove.3.In terms of objective indicators,acupuncture can mainly improve the conduction velocity of sensory nerve of sural nerve,the conduction velocity of sensory nerve of ulnar nerve and the conduction amplitude of sural nerve.The first two grades are recommended by "moderate",and the sural nerve conduction amplitude is recommended by "very low";Other objective indexes need strict and standard experimental design to prove.4.In terms of safety,acupuncture therapy was relatively safe,and only one adverse event occurred in the experimental group to a lesser extent.Therefore,this therapy can be applied to patients with peripheral nerves caused by chemotherapy who can receive acupuncture treatment.5.The quality of the included literature of this topic is uneven,and most of the experimental designs are not standardized.The above conclusions need to be further confirmed by more rigorous experiments. |
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