Yin Zihan, Geng Guoyan, Xu Guixing, Zhao Ling, Liang Fanrong
School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi Er Qiao Road, Chengdu, 610075 China.
Chin Med. 2020 Oct 12;15:109. doi: 10.1186/s13020-020-00389-9. eCollection 2020.
Allergic rhinitis (AR) is a common symptomatic, inflammatory, and immunological disorder of nasal mucosa. Multiple clinical trials and systematic reviews have implicated acupuncture methods as potentially effective treatment strategies for AR, however, considering the great burden of AR, it is crucial to explore the most recent clinical evidence supporting acupuncture in AR. Besides, the methodologies reported in previous studies as well as those commonly applied during clinical practices greatly vary. Herein, we conducted network meta-analysis to compare the effectiveness of diverse acupuncture methods for AR treatment.
We conducted a literature search for relevant reports published from inception to 1 July 2020 in several scientific databases, including PubMed, Embase, Cochrane library, Web of Science, CNKI, WF, VIP, CBM, AMED as well as related registration platforms. Primary outcomes as reported in the identified studies were assessed using nasal symptoms. All Meta-analyses were performed with RevMan, ADDIS, and STATA software. To ensure consistency among our reviewers, the intra-class correlation coefficient was used.
Exactly 39 studies with 3433 participants were covered in this meta-analysis. The meta-analysis demonstrated that all acupuncture types were superior to sham acupuncture in terms of total nasal symptom score and rhinoconjunctivitis quality of life questionnaire. Moxibustion was recommended as the most effective intervention as it reduced nasal symptoms in 6 treatments. On the other hand, manual acupuncture plus conventional medicine was recommended as the most effective intervention in improving the quality of life in 9 treatments. Notably, moxibustion was recommended as the most effective intervention that changed the content of IgE in 9 treatments. Moreover, adverse events of these interventions were acceptable.
Our findings revealed that all acupuncture methods are effective and safe for AR. Moreover, either moxibustion or manual acupuncture plus conventional medicine are potentially the most effective treatment strategies for AR. Based on these findings, it is evident that acupuncture therapy is not inferior to pharmacologic therapy. Therefore, for AR patients who are either unresponsive to conventional medicine or are intolerant to adverse events, acupuncture therapy should be administered. However, the quality of these included trials was mainly ranked as moderate quality, we recommend additional well-designed RCTs with larger sample sizes to validate these findings.
变应性鼻炎（AR）是一种常见的鼻腔黏膜症状性、炎症性和免疫性疾病。多项临床试验和系统评价表明针刺方法可能是治疗AR的有效策略，然而，考虑到AR的巨大负担，探索支持针刺治疗AR的最新临床证据至关重要。此外，先前研究报告的方法以及临床实践中常用的方法差异很大。在此，我们进行了网络荟萃分析，以比较不同针刺方法治疗AR的有效性。
我们在多个科学数据库中检索了从创刊到2020年7月1日发表的相关报告，包括PubMed、Embase、Cochrane图书馆、Web of Science、CNKI、WF、VIP、CBM、AMED以及相关注册平台。使用鼻症状评估纳入研究报告的主要结局。所有荟萃分析均使用RevMan、ADDIS和STATA软件进行。为确保我们的评价者之间的一致性，使用了组内相关系数。
本荟萃分析共纳入39项研究，3433名参与者。荟萃分析表明，在总鼻症状评分和鼻结膜炎生活质量问卷方面，所有针刺类型均优于假针刺。艾灸被推荐为最有效的干预措施，因为它在6次治疗中减轻了鼻症状。另一方面，手针加传统药物被推荐为在9次治疗中改善生活质量的最有效干预措施。值得注意的是，艾灸被推荐为在9次治疗中改变IgE含量的最有效干预措施。此外，这些干预措施的不良事件是可以接受的。
我们的研究结果表明，所有针刺方法治疗AR都是有效且安全的。此外，艾灸或手针加传统药物可能是治疗AR最有效的策略。基于这些发现，显然针刺疗法并不逊色于药物疗法。因此，对于对传统药物无反应或不耐受不良事件的AR患者，应采用针刺疗法。然而，这些纳入试验的质量主要被评为中等质量，我们建议进行更多设计良好、样本量更大的随机对照试验来验证这些发现。
