| Objective:This study is based on the clinical randomized controlled trial(RCT),taking chronic tension type headache(CTTH)patients as the research object and acupuncture treatment as the intervention means.Single factor and binary logistic regression analysis were used to analyze the correlation between the clinical effect and influencing factors of acupuncture on CTTH patients,and to explore the related factors that affect the clinical effect of acupuncture on CTTH,so as to provide the basis for evaluating the prognosis of acupuncture on CTTH.Methods:A total of 218 patients with CTTH who met the diagnostic criteria were recruited.All patients were randomly divided into deep needling group and shallow needling group,109 cases in each group.The acupuncture selection points in the two groups were selected from Baihui,Fengchi,Taiyang,Hegu,Taichong.After the deep acupuncture group used a trocar acupuncture needle to break the skin and insert the needle,immediately removed the tube,continued to insert the needle to a certain depth,and performed techniques to maintain “De-qi”,leaving the needle for 30 minutes,shaking the handle once every 10 minutes,a total of 2 times;In the shallow acupuncture group,the needle was inserted into the needle until the depth of the needle was flush with the end of the trocar(about 2mm),it is not required to get“De-qi”,keep the needle for 30 min,and do not shake the handle during the period.The treatment period was 8 weeks,3 times a week in the first 4 weeks,2 times a week in the last 4 weeks,a total of 20 times.The main outcome measures were response rate,the secondary measures were improvement of headache days,improvement of average headache duration,improvement of Visual Analogue Scale(VAS)of average headache degree,reduction rate of therapeutic drugs,number of concomitant symptoms,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),36-Item Short Form Health Survey(SF-36)and expectation evaluation compared with baseline.In order to explore the related influencing factors of acupuncture effect,183 patients who completed the third visit(at the end of treatment)and the fifth visit and had no less than 50% of treatment times were selected.Compared with the number of headache days in the baseline period,the number of headache days during the two visits with a reduction rate of more than 50% were defined as "response group",while those with a reduction rate of less than 50% were defined as "non-response group".Baseline period data of demographic data,chronic headache history,comorbid disease data,headache history within 4 weeks,SF-36 score,anxiety and depression scale score,expectation evaluation,acupuncture times and acupuncture grouping and clinical efficacy response grouping were subjected to single factor and binary logistic regression analysis in order to screen out the relevant influencing factors in two visits,and to evaluate the difference between the immediate and long-term effects of the relevant factors affecting the clinical efficacy of acupuncture.Results:1.A total of 183 CTTH patients were selected for correlation analysis.In the third visit,there were 89 cases in response group,94 cases in non-response group,60 cases in deep acupuncture group and 29 cases in shallow acupuncture group.In the fifth visit,119 cases were in response group,64 in non-response group,75 in deep acupuncture group and 44 in shallow acupuncture group.2.Single factor analysis of the third visit: 13 candidate factors were selected from the comparison of the two groups,which were baseline period data of headache nature,headache duration,period of headache attack,medications for comorbid diseases,headache days in 4 weeks,headache duration in 4 weeks,therapeutic drug use in 4 weeks,drug use in comorbid diseases in 4 weeks,social functioning dimension,HAMA total score,headache relief expectation,relationship between acupuncture sensation and curative effect,acupuncture grouping.Note: in order to avoid missing candidate factors that may have influence,P < 0.15 was taken for single factor analysis.3.Binary logistic regression analysis of the third visit: Baseline period data ofheadache days in 4 weeks,social function dimension and acupuncture grouping had a significant effect on the short-term efficacy of acupuncture for CTTH patients(P<0.05).With the number of headache days increases within 4 weeks of the baseline period,and the likelihood of a short-term therapeutic response will decreases(OR =0.863,95% CI 0.815 ? 0.915,P = 0.000);With the patient's social function score increases at baseline,and the likelihood of a short-term therapeutic response will increases(OR = 1.037,95% CI 1.004 ? 1.071,P = 0.027);Patients in the deep acupuncture group are more likely to have a short-term therapeutic response than patients in the shallow acupuncture group(OR = 3.094,95% CI 1.592 ? 6.011,P =0.001).4.Single factor analysis of the fifth visit: 9 candidate factors were selected from the comparison of the two groups,which were baseline period data of headache aura,general health dimension,social function dimension,headache days in 4 weeks,HAMA rating,headache relief expectation,relationship between acupuncture sensation and curative effect,acupuncture grouping,acupuncture times.Note: in order to avoid missing candidate factors that may have influence,P < 0.15 was taken for single factor analysis.5.Binary logistic regression analysis of the fifth visit: Baseline period data of headache days in 4 weeks,general health dimension,social function dimension,headache relief expectation,acupuncture times and acupuncture grouping had a significant effect on the long-term efficacy of acupuncture for CTTH patients(P<0.05).With the number of headache days increased within 4 weeks of the baseline period,and the likelihood of long-term therapeutic response will decreases(OR =0.934,95% CI 0.876 ? 0.995,P = 0.035);With the patient's general health score increases at baseline,and the likelihood of long-term therapeutic response will decreases(OR = 0.950,95% CI 0.911 ? 0.990,P = 0.015);With the patient's social function score increases at baseline,and the likelihood of long-term therapeutic response will increase(OR = 1.038,95% CI 1.004 ? 1.073,P = 0.030);With the patient's expectation of headache relief at baseline increases,and the likelihood of long-term therapeutic response will increases(OR = 1.179,95% CI 1.010 ? 1.376,P= 0.037);With the increase of acupuncture times,the likelihood of long-term therapeutic response will increase(OR = 1.212,95% CI 1.027 ? 1.432,P = 0.023);Patients in deep acupuncture group are more likely to have long-term therapeutic response than patients in the shallow acupuncture group(OR = 3.554,95% CI 1.766 ?7.153,P = 0.000).Conclusion:1.The response rate of long-term therapeutic effect of acupuncture is better than that of short-term therapeutic effect.2.The short-term effect of acupuncture on CTTH patients may be related to headache days in the baseline period,social function dimension in the baseline period and acupuncture grouping.3.CTTH patients in the deep acupuncture group with fewer headache days and high social function scores in the baseline period are more likely to respond to the short-term effect of acupuncture,and the effect of acupuncture may be better.4.The long-term effect of acupuncture on CTTH patients may be related to headache days in the baseline period,general health dimension in the baseline period,social function dimension in the baseline period,headache relief expectation in the baseline period,acupuncture times and acupuncture grouping.5.CTTH patients in the deep acupuncture group with fewer headache days in the baseline period,low score of general health dimension in the baseline period,high score of social function dimension in the baseline period,high expectation of headache relief in the baseline period and many times of needling were more likely to respond to the long-term effect of acupuncture,and the effect of acupuncture might be better. |
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