Meta-analysis Of Acupuncture Combined With Acupoint Injection In The Treatment Of Idiopathic Facial Paralysis

Purpose: Under the guidance of evidence-based medicine,the efficacy and safety of clinical studies on acupuncture combined with acupoint injection in the treatment of idiopathic facial nerve palsy were evaluated by means of Meta analysis,so as to provide reference for clinical diagnosis and treatment.Materials and methods: We searched Chongqing VIP,CBM,CNKI,Wanfang database,Pub Med,Springer,Elsevier SD,and Web of by computer Science(SCI)and Journal Citation Reports(JCR)literatures on randomized clinical trials(RCTs)and semi-randomized controlled trials(CCTs)of acupuncture combined with point injection in the treatment of idiopathic facial nerve palsy were searched from the establishment of the database to November 2020.Literature not included in the database was supplemented by manual search.According to the established inclusion and exclusion criteria,the literature was screened,and then the literature included in this study was determined.The quality of the included studies was evaluated using the "Risk of Bias Assessment Tool" recommended by the Cochrane Collaboration.Meta-analysis was performed using Rev Man5.3 and Stata14.0 software.Results:Meta-analysis results of the 22 included literatures were as follows:1.There were 22 trials of acupoint injection + acupuncture VS acupuncture.Compared with the TCM group alone,the heterogeneity was statistically significant(P=0.006,I2=48.8%),so the fixed effect model was used for combined analysis.Meta-analysis results showed that there was a statistically significant difference in overall effective rate between the two groups[RR=1.21,95%CI(1.17,1.26)],that is,the clinical efficacy of acupoint injection combined with acupuncture therapy was better than that of acupuncture therapy alone.Fig.7 Forest plot shows that the horizontal lines of 12 of the 22 trials intersect with invalid lines,that is,12 trials have no statistical significance.In Fig.8,Zhuo Yi was used to perform sensitivity analysis by eliminating references,and the sensitivity analysis showed that the results were relatively robust.Figure 9 point injection plus acupuncture VS acupuncture 22 test total effective funnel chart pattern is not symmetrical,but thinks that there are certain publication bias,22 trials using STATA software,egger and begg analysis results egger P = 0.00,publication bias is greater than 0.05 indicating existence,begg analysis results P = 0.001,more than 0.05 also show that there exist publication bias.2.Regression analysis and subgroup analysis: according to the results of forest map,I2=48.8%,though less than 50%,still belongs to medium heterogeneity.In order to make the results more robust,sources of heterogeneity need to be found.Through careful analysis of the literature,summarizes the three sources of heterogeneity,year of publication,the course of(A)(B)(C),point injection drug to Permute Meta regression results(monte carlo method)operation correction(Permutations = 5000),in conclusion,according to the results of the course(B)(P = 0.016,less than 0.05,the course is likely to be efficient sources of heterogeneity,always need to course group,subgroup analysis.Through careful reading of the literature,the 22 included literatures were divided into two groups according to whether they were in acute stage or not.However,there were three literatures that did not mention whether they were in acute stage,so one more group was compiled,making up a total of three groups.Subgroup analysis was conducted.The results of forest diagram in Figure 11 showed that I2=0% in each group,but the outcome remained unchanged.Total I2=48.8%,indicating that the length of disease duration may be the source of heterogeneity.It was proved that the conclusion was stable.Acupoint injection + acupuncture was better than single acupuncture group.3.Analysis of healing significance: 15 trials of acupoint injection + acupuncture VS acupuncture provided healing significance.Compared with the acupuncture alone group,the heterogeneity was statistically significant(P=0.00,I2=69.2%),and the random effect model was used for combined analysis.Fig.12.Meta-analysis results showed that there was a statistically significant difference in the overall effective rate between the two groups[RR=1.34,95%CI(1.08,1.67)],that is,the clinical efficacy of acupoint injection plus acupuncture therapy was better than that of acupuncture therapy alone.The forest plot showed that the horizontal line of 10 of the 11 trials intersected with the invalid line,that is,11 trials had no statistical significance.Sensitivity analysis is done due to heterogeneity.Fig.13.The results showed that the heterogeneity of two literatures was reduced after the elimination by Wang Weijie and Cai Lisong.Figure 14 + 15 acupuncture VS acupuncture point injection test total effective funnel chart pattern is not symmetrical,but thinks that there are certain publication bias,15 trials using STATA software egger and begg analysis at the same time,the results egger P = 0.024,less than 0.05 shows that there exist publication bias,begg analysis results P = 0.038,less than 0.05 also shows that there exist publication bias.3.Average cure time: 3 out of the 22 included literatures described the onset time after treatment,and the shorter the cure time,the better the curative effect.The heterogeneity of acupuncture combined with acupoint injection group was statistically significant(P=0.002,I2=82.7%)compared with that of acupuncture alone group.The random-effect model was used [WMD=-5.27,95%CI(-7.99,2.56)],P=0.003.The combination of the three literatures had statistical significance,but the heterogeneity was too high,possibly due to the small number of literatures and large difference in sample size.The results are not robust enough.Conclusion:1.Meta-analysis results of 22 literatures included in this study showed that acupoint injection combined with acupuncture in the treatment of facial nerve palsy was better than acupuncture alone in improving the overall effective rate,recovery rate and time of effect onset.Therefore,the clinical effect of acupoint injection combined with acupuncture is better than that of acupuncture alone,which can provide a reliable basis for clinical treatment.2.The 22 literatures included in this study had some problems in allocation concealment and blind method implementation,which may be related to the design of the experiment itself,but did not affect the conclusion.