Clinical Study Of Acupuncture Therapy In The Prevention And Treatment Of Thrombocytopenia Caused By Chemotherapy

Chemotherapy-induced thrombocytopenia(CIT)is a common complication of tumor chemotherapy.The main mechanism of its occurrence is that anti-tumor chemotherapy drugs kill cancer cells while also inhibiting bone marrow megakaryocytes,a platelet precursor cell,which leads to a decrease in platelet count.Epidemiology shows that the overall incidence of CIT is 9.7%,with the highest incidence of regimens containing gemcitabine,carboplatin and other chemotherapy drugs.The occurrence of CIT can cause serious consequences,such as the reduction of the dose of chemotherapy drugs,the delay of chemotherapy time,and even termination of chemotherapy.It may also increase the bleeding risk of patients and ultimately affect the survival time of patients.At present,the commonly used methods for prevention and treatment of CIT in Western medicine,such as platelet transfusion,the application of platelet growth factors(interleukin-11,thrombopoietin),etc.,are indeed effective,and can increase the platelet count and shorten the platelet recovery time after chemotherapy.However,there are problems such as possible infection of infectious diseases,blood transfusion reactions,obvious side effects,and high prices.Chinese medicine has the effect of increasing the efficacy and reducing the toxicity of chemotherapy.In recent years,there have been more and more studies on the application of Chinese medicine treatment methods to prevent and treat side effects of chemotherapy.Many doctors have used single herbs,self-made prescriptions,or Chinese patent medicines to treat CIT,and have achieved certain results.However,it is undeniable that this type of therapy has a long course of treatment and slow onset of action,and because of the different evaluation criteria,its efficacy remains to be further studied.Therefore,there is an urgent need to find a method for preventing and treating CIT with good curative effect,high safety,quick effect and low cost.The acupuncture treatment method has no toxic and side effects,simple operation and low price,but its effect is yet to be evaluated.Instructor Professor Jinchang Huang found that in the practice of clinical treatment of CIT,blood cupping at BL18 and BL 20 can quickly increase the platelet count of CIT patients.Therefore,this study conducted a meta-analysis of the literature on the prevention of CIT by acupuncture therapy and retrospectively analyzed the clinical data of the treatment of CIT patients with blood cupping therapy,and evaluated the clinical efficacy of acupuncture therapy and blood cupping in the prevention and treatment of CIT,and provided a basis for clinical promotion.Purpose:This study explored the clinical efficacy of acupuncture therapy to prevent CIT through Meta-analysis;retrospectively analyzed the clinical data of patients undergoing blood cupping therapy for CIT to evaluate the efficacy and safety of blood cupping therapy for CIT.Methods:(1)Retrieving Randomized Controlled Trials(RCT)on seven databases from the establishment of the database to February 2020 on the prevention of acupuncture therapy CIT.According to the criteria for screening and extraction of relevant data,Revman 5.3 was used for Meta-analysis.(2)From August 2015 to January 2020,patients with CIT hospitalized in the Department of Acupuncture and Minimally Invasive Oncology,the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were taken as the research object,and 64 patients were included according to the criteria for inclusion.Extract the patient's gender,age,primary disease,previous chemotherapy times and other information as baseline data,with treatment efficiency,platelet count(PLT),platelet recovery time,MPV,PDW,PLCR,PCT,WBC,RBC,Hb,ALT,AST,BUN,CREA,APTT,PT,FIB,TT,adverse reactions as observation indicators to evaluate the clinical efficacy and safety of BL18 and BL20 blood cupping therapy for CIT.Results:(1)Finally,13 studies were included and 4 articles reported the occurrence of CIT events.The results showed that patients treated with acupuncture therapy had a lower probability of CIT(RR=0.41,95%CI[0.20,0.87],Z=2.32,P=0.02);11 articles reported specific platelet counts after intervention,and the results showed that the subjects who received acupuncture treatment had higher platelet counts than those without therapy(MD=16.28×109/L,95%CI[0.80,31.76],P=0.04);8 articles reported changes in the KPS score,and the results showed that the subjects who received acupuncture treatment had higher KPS than those without therapy(MD=6.69,95%CI[6.22,7.16],P<0.00001).(2)A total of 64 patients were included.After 1 course of treatment,51 patients were effective,with an effective rate of 79.69%.The t-test p=0.00<0.05 before and after the blood cupping intervention of patients,suggesting that blood cupping can effectively increase the platelet count of CIT patients.Before and after intervention,MPV,PDW,PLCR,and PCT were tested with p-values less than 0.05,combined with clinical findings that blood cupping had no significant effect on platelet parameters.The median number of days for platelets to return to normal is 10 days,and the effect is rapid.The value of liver function related index ALT before intervention was 25.47±19.09,21.42±16.43 after blood cupping,p value was less than 0.05,combined with clinical findings that blood cupping did not cause liver damage.The statistical p-values of other observation indicators WBC,RBC,Hb,AST,BUN,CREA,APTT,PT,FIB,TT,D-D,etc.are all greater than 0.05,indicating that blood cupping have no significant effect on the above indicators.In 64 patients,only the skin stasis,blisters and other related adverse reactions occurred,which resolved spontaneously,without serious adverse reactions,and the safety was good.Conclusions:(1)Acupuncture therapy can effectively prevent the reduction of platelet count after chemotherapy,reduce the degree of platelet reduction,prevent the occurrence of CIT,and have fewer adverse reactions.(2)BL18 and BL20 blood cupping can effectively improve the platelet count level of CIT patients and speed up the recovery of platelets,without obvious liver and kidney toxicity and serious adverse reactions,with high safety and worth promoting in clinical practice.