An Evidence Map And Network Meta-analysis Of Different Acupuncture And Moxibustion Treatments For Allergic Rhinitis Based On GRADE Classification

Objective:Network meta-analysis was used to compare the efficacy of different acupuncture and moxibustion treatments in the treatment of allergic rhinitis(AR).The evidence level of randomized controlled trial studies was evaluated through GRADE evidence quality grading system,and the evidence atlas was used for visual analysis,so as to provide evidence-based evaluation evidence for clinical acupuncture treatment of AR.Method:Randomized controlled trials on acupuncture therapy for AR were comprehensively collected through electronic retrieval of CNKI,VIP,WF,Chinese Biomedical Literature Database(CBM),PubMed,Embase,CochraneLibrary and other databases,combined with manual retrieval.The final study was established according to the scheduling criteria.The data included in the study were extracted using Excel 2016,and then the methodological quality of the included literature was assessed using ROB2.0.The CONSORT and STRICTA entries were used to evaluate the reporting quality.Frequency statistical analysis method was used to conduct mesh meta-analysis with STATA16.0 software,and various outcome charts of mesh meta-analysis were obtained.OR was used as the effect value for binary variables and SMD was used as the effect value for continuous variables.95%CI of each was calculated.The "ring method" was used to test the inconsistencies of the closed rings formed in the mesh meta-analysis.If there were inconsistencies,the node splitting method was continued to detect local inconsistencies.If there is still inconsistency,the efficacy ranking and league chart of different interventions on the same outcome index are obtained by using the inconsistency model to calculate the results,and sensitivity analysis is carried out to determine whether the results are stable.If the consistency is good,the consistency model is used to calculate.The ranking and percentage results of each intervention are shown in the SUCRA chart.The results of the comparation-corrected funnel plot were used to analyze inclusion studies for publication bias or small sample effects.According to the GRADE evidence quality grading system,five outcome indicators were graded according to the importance of outcome indicators,and the evidence quality levels of the studies under the five outcome indicators were evaluated respectively.The quality of the evidence included in the study was presented using the results visualization tool evidence map.Results:1.116 RCTS with a total of 9473 patients were finally included in this study.Among them,111 two-arm studies and 15 three-arm studies were included,including 17 single acupuncture treatment methods,such as millineedle acupuncture;Moxibustion;Electric needle;There are 4 kinds of acupuncture treatment methods,which are acupuncture combined with moxibustion;Acupuncture combined with lightning moxibustion;Acupuncture combined with heat-sensitive moxibustion;Acupuncture combined with ginger moxibustion.2.There is a certain risk of bias in the studies included in this study,including 9 studies with high risk of bias,83 studies with certain risk,and 24 studies with low risk.Most studies do not mention or omit blind methods.3.All the included studies mentioned the research background in the abstract,104 studies detailed the research purpose,and 5 studies mentioned the research design scheme.Most studies illustrate randomized ways to group patients for inclusion.There are 22 studies describing the assignment of treatment measures,hiding and blinding.Twenty-five studies mentioned reasons for shedding or withdrawal of patients in each group during treatment.All the included studies gave specific effect values for their outcome indicators.Forty-five studies of adverse reactions in patients during treatment were documented.15 studies with trial registration number and protocol were provided,and 25 studies with explicit funding support were provided.4.Mesh Meta analysis showed that:The total effective rate of bee acupuncture therapy was better than acupuncture therapy.Compared with western medicine,natural moxibustion,acupuncture combined with moxibustion has better curative effect;Acupuncture combined with moxibustion is superior to placebo.The above differences were statistically significant,while the other interventions were not statistically significant.Probability ranking results acupuncture combined with moxibustion was the best.The overall consistency of the outcome was poor,but the local consistency was good.There was no publication bias or small sample effect.In terms of improving TNSS:acupuncture combined with moxibustion has better effect on improving TNSS than electric acupuncture,moxibustion,acupuncture,lightning moxibustion,heat sensitive moxibustion and natural moxibustion.The above differences were statistically significant,while the other interventions were not statistically significant.Probability ranking results acupuncture combined with moxibustion was the best.This outcome has good local consistency but poor overall consistency,which may lead to publication bias or small sample effect.TNNSS reduction:moxibustion,acupuncture combined moxibustion is better than electric acupuncture.Moxibustion is superior to acupuncture,warm moxibustion,heat-sensitive moxibustion,heavenly moxibustion and Western medicine.Acupuncture combined with moxibustion is superior to acupuncture,heat sensitive moxibustion,natural moxibustion and Western medicine.The above differences were statistically significant,while the other interventions were not statistically significant.Probability ranking results of Du Mai Pu moxibustion best.This outcome is consistent,and some studies have small sample sizes,which may lead to publication bias or small sample effect.In terms of improving RQLQ,heat-sensitive moxibustion was better than western medicine,electric acupuncture and acupuncture in improving life quality,and the results were statistically significant.The residual comparison was not statistically significant.Probability ranking results heat sensitive moxibustion best.The results showed good consistency and small publication bias or small sample effect.In terms of reducing IgE in serum,Du Mai Pu moxibustion and thunder fire moxibustion were better than western medicine.Umbilical needle is superior to western medicine,acupuncture,moxibustion,bee needle and lightning moxibustion.Heat sensitive moxibustion is better than the Dumai shop moxibustion,bee needle,thunder and fire moxibustion,umbilical needle.Natural moxibustion is better than umbilical needle.Warm moxibustion is superior to western medicine,acupuncture,moxibustion,bee acupuncture and lightning moxibustion.The result of probability sorting was umbilical needle.The results were consistent without publication bias or small sample effect.5 GRADE Evidence quality ratingThe importance of five outcome indicators was evaluated according to the GRADE evidence quality grading system,and then the quality of research evidence under each index was graded.The final results were as follows:overall clinical response rate,TNSS,TNNSS,IgE and other four outcome indicators belonged to low quality evidence,while RQLQ belonged to medium quality evidence.6 Evidence MapAccording to the results of GRADE evidence quality classification,among the 116 RCTS included,medium quality evidence was the largest,followed by low quality evidence,and only four studies were of very low quality.In terms of total response rate,42(62.69%)studies were of medium quality,23(34.32%)studies were of low quality,and 2(2.98%)studies were of very low quality.In terms of TNSS,14(51.85%)studies were of medium quality,12(44.4%)studies were of low quality,and 1(3.7%)studies were of very low quality.In terms of TNNSS,8(72.72%)were of low quality and 3(27.27%)were of medium quality.In terms of RQLQ,16(76.19%)were of medium quality and 5(23.8%)were of low quality.IgE:Medium quality evidence in 2(20%),low quality evidence in 7(70%),very low quality evidence in 1(10%).Conclusion:1.According to the results of mesh meta-analysis,acupuncture is better than other drugs in the improvement of the total effective rate,TNSS,TNNSS,RQLQ and IgE in the treatment of AR.The clinical total effective rate of acupuncture combined with moxibustion is the best.The combination of acupuncture and moxibustion on TNSS can significantly reduce the effect.Moxibustion is the best for improving non-nasal symptoms.Heat sensitive moxibustion has the best effect on improving quality of life.Umbilical needle therapy is most beneficial for lowering serum IgE.2.According to the results of GRADE evidence grade and evidence map,the evidence quality of the included studies needs to be improved,and high-quality evidence is less.In order to help the clinical decision-making of allergic rhinitis,evidence-based evidence of better quality is also needed.