| Purpose: Meta-analysis and rule study of a randomized controlled trial of acupuncture combined with Chinese herbal medicine for the cure of allergic rhinitis was conducted with the aim of assessing its relevant efficacy,finding the regularity and trend,exploring the clinical value of the combination of acupuncture and medicine,providing reliable evidence-based medicine for the clinical treatment of allergic rhinitis at this stage,and exploring the shortcomings and drawbacks of clinical trials related to the treatment of this disease by Chinese medicine in order to fill the gaps in the relevant clinical evidence.Methods: In terms of meta-analysis,a comprehensive collection of randomized controlled clinical trials on acupuncture combined with oral administration of traditional Chinese medicine in the cure of allergic rhinitis was put into effect.Search the literature from Sino Med,Pub Med,EMbase,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP Database for Chinese Technical Periodicals.Search time from library build to January 2023.Patients clinically diagnosed with anaphylactic rhinitis were incorporated in the study.The combination of acupuncture and Chinese herbal medicine was chosen for the observation group,and conventional western medicine treatment,Chinese herbal medicine alone,and acupuncture treatment alone were used as interventions for the control group.Based on the inclusion and exclusion criteria,2 researchers screened the literature separately,then cross-checked and extracted the information.The quality of the document was evaluated on a case-by-case basis using Jadad,Cochrane as a scale for risk assessment,and all included literature was put into Stata14 and Revman 5.3 software to perform a systematic analysis of their valid data.Clinically effective,total score nasal symptoms,relevant quality of life scores,serum immunological indicators,relapse rate,comparing the efficacy and safety of the above outcome indicators.Q test was performed to determine the heterogeneity of the included literatures.If I2 ≤50% and P>0.1,the heterogeneity was little,and fixed effect model was chose.If I2>50% and P<0.1,it indicates large heterogeneity,the stochastic effects pattern was adopted,and search for the source of heterogeneity.For continuous variables,mean difference(MD)or standardized mean difference(SMD)was used.For dichotomous variables,relative risk(RR)was used as effect size analysis,and the confidence interval was 95%CI.Funnel plot and Egger ’test were used to test publication bias.In terms of research of regularity: TCM compounds and acupoint prescriptions were extracted from the final entry of meta-analysis,and TCM names were standardized according to the Pharmacopoeia of the People’s Republic of China,Chinese Materia Medica and Chinese Pharmacy,and names of acupoints were standardized according to the Acupuncture and Moxibustion Science.Frequency analysis was carried out in Excel database and association rules were analyzed by R software.Results: A total of 651 papers were searched and,after rigorous screening,47 qualified papers in Chinese and 2 in foreign languages were finally included.49 studies with a total sample size of 4220 cases,1890 in the trial group(shedding 33cases)and 2330 in the control group(disengaging 51 cases),with 4136 patients with complete experimental procedures,were included in the study.Meta-analysis showed that:1 45 studies reported on the overall effectiveness rate as a trial indicator,with the overall effectiveness of the combination treatment being higher than other treatments,and the discrepancy was statistically meaningful,[exp(b)=2.81,95%CI:2.09~3.79,Z=6.830,P=0.000],[exp(b)=2.81,95%CI:2.41~3.29,Z=12.949,P=0.000].2 The treatment of serum lg E was reported in 7 studies.The reduction of lg E content in experimental group was superior ro that in matched group,[MD=-28.48,95%CI :-31.47 ~-25.49,Z=18.66,P < 0.00001],and the discrepancy was statistically meaningful.3 Serum IL-4 was used as the outcome index in 6 studies.Acupuncture combined treatment group could reduce serum IL-4 level to a certain extent,and the decrease was slightly larger than the control group,and the discrepancy was statistically meaningful.[SMD=-1.01,95%CI:-1.50~-0.51,Z=4.00,P<0.00001].4 Four studies recorded the changes of serum IFN-γ content in AR patients before and after treatment,and the experimental group and matched group had the same efficacy,[MD=1.26,95%CI:0.79~1.73,Z=5.27,P<0.0001],it was statistically significant.5 RQLQ scores were evaluated in 9 literatures,and the combination of acupuncture and drug therapy was more advantageous in improving quality of life,and the discrepancy was statistically meaningful,[SMD=-1.22,95%CI:-1.97~-0.48,Z=3.23,P=0.001].6 The total score outcome index of nasal symptoms was used in 18 studies.On account of the heterogeneity of control interventions,subgroup analysis was performed.Traditional Chinese medicine control group [SMD=-0.79,95%CI:-0.95~-0.63,Z=9.80,P<0.00001],western medicine control group [SMD=-0.79,95%CI :-1.03 ~-0.55,Z=6.41,P < 0.00001],acupuncture control group[SMD=-0.81,95%CI:-1.07~-0.54,Z=5.96,P<0.00001],Compared with other treatments,the combination of acupuncture and drug therapy could effectively relieve the clinical symptoms of patients,and the discrepancy was statistically meaningful.7 Patients were followed up in five studies,and the recurrence rate in the acupuncture group was inferior to that in the matched group,[RR=0.42,95%CI:0.30 ~ 0.60,Z=4.77,P < 0.00001],and the discrepancy was statistically meaningful.The result of a rule study:A total of 108 traditional Chinese medicines and 56 acupoints were involved in49 literatures.The top 10 most frequently used Chinese medicines were Astragalus,Fangfeng,Atractylodes Rhizome,Xinyi,Liquorice,cocklebur,asarum,angelica dahurica,Schisandra and cassia twig.Fangfeng→Astragalus had the highest correlation with 0.722 support.Fangfeng,Atractylodes Rhizome→Astragalus had the highest correlations with 0.667.Astragalus,Xinyi,Atractylodes Rhizome→Fangfeng had the highest correlations with 0.593.The top 10 most frequently used acupoints were Yingxiang,Yintang,Hegu,Feishu,Zusanli,Bitong,Fengchi,Pishu,Shenshu and Dazhui.Binomial association Bitong→Yintang had the highest correlation with 0.362 support,and three correlation analysis Yingxiang,Hegu→Yingxiang had the highest support with 0.383 support.Conclusion: Acupuncture combined with herbal therapy has potential advantages over other therapies in relieving clinical symptoms,improving quality of survival,down-regulating the possibility of recurrence,and improving serum Lg E and IL-4 levels;no advantage was seen in the modulation of serum IFN-γ.Clinical drugs were mainly used to tonify the lung and spleen,and promote the nasal passages,choose Astragalus,Fangfeng,Atractylodes Rhizome,etc.The main acupoints were Yingxiang,Yintang,Hegu,etc.Given the quantitative and qualitative astrict of now available studies,more randomised controlled studies with large sample sizes,rigorous experimental designs and multicentricity are needed for further validation. |
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