The Meta Analysis And Systematic Review Of Acupuncture For Peripheral Facial Paralysis At Acute Stage

ObjectiveThe meta analysis and systematic review were carried out to evaluate the efficacy and the scores of scales of acupuncture for peripheral facial paralysis at acute stage,in order to provide evidence-based medical evidence for treatment strategies.Methods1.Search methods:Based on search strategy,the randomized controlled trials(RCT)of acupuncture for peripheral facial paralysis at acute stage were searched at home and abroad.2.Include and exclusion criteria:At the acute stage of peripheral facial paralysis,the treatment group adopt acupuncture or combination with other therapy(the same with control group),and the control group,sham acupuncture,a placebo,western medicine,and other therapy(except acupuncture).Out of the acute stage,two group treat with the same acupuncture therapy.The type of the study was designed as RCT.The duplicate publications were excluded.3.Data extraction and quality evaluation:According to the include and exclusion criteria,data extraction and quality evaluation were carried out by 2 researchers independently.The quality evaluation was assessed by Cochrane 5.1.0 software and Jadad scale.4.Data analysis:Rev Man5.3.5 statistical software was used for the data analysis.The dichotomous data was presented as Relative Risk(RR)OR Odds Ratios(OR),and the continuous variable data was presented as Weighted Mean Difference(WMD).If the continuous variable difference between studies is large,consider the difference in measurement methods and use Standard Mean Difference(SMD)for Meta-analysis.If the evidence of the data are insufficient,only descriptive analysis will be carried out.Heterogeneity test:heterogeneity test is carried out on multiple research results to judge whether multiple studies are homogeneous or not.chi-square test is used for heterogeneity test between the included research results,P value is set as 0.1,and I~2is used for statistical heterogeneity.When P>0.1 and I~2<50%,multiple similar studies can be considered to be homogeneous,and a Fixed Effect Model(FE)is adopted.When P≤0.1 and I~2≥50%,it indicates that there is heterogeneity between the studies.The sources of heterogeneity are analyzed and subgroup analysis is carried out according to possible heterogeneity factors.After eliminating the problems of research design quality and different treatment schemes,the Random Effect Model(RE)can be used to combine the effect quantities and carefully explain the research results.Sensitivity analysis is used to analyze the stability of test results when necessary.If the heterogeneity is too large to judge its source,Meta analysis is abandoned and descriptive analysis is used instead.5.Evaluation of publication bias:Rev Man5.3.5 statistical software was used to draw funnel chart for detection of publication bias.ResultsA total of 26 articles,29 studies(which 3 articles including 2 studies)were included in this study,all of which were Chinese articles.A total of 2,483 patients with peripheral facial paralysis at acute stage were included in this study.According to Cochrane System Evaluator Manual 5.1.0 Bias Risk Assessment Tool,26 studies are low bias studies and 3 studies are high bias risk studies.According to the Jadad scoring scale,there are 6 high-quality studies and the rest are low-quality studies.The publication bias of the included study was detected,and the funnel chart was drawn,showing that the quality of the studies included in the study was good,and the funnel chart was basically symmetrical between left and right,suggesting that the possibility of publication bias was low.According to the difference of outcome indexes and the results of heterogeneity test,the total effective rate,Traditional Chinese Medicine(TCM)symptoms and signs scores,Facial Disability Index(FDI)social function scores,Portmann scale score and facial nerve function scores were quantitatively analyzed,and the recovery time,House-Brackmann scores,FDI physical function scores,Eno G value of facial nerve electrogram and serum Ig G,Ig A and Ig M levels were qualitatively analyzed.(1)The results of quantitative analysis showed:(1)Total effective rate:the treatment group was significantly better than the control group[OR=3.29,95%CI(2.43,4.44),P<0.00001];(2)TCM symptom and sign score:the treatment group can significantly reduce the TCM symptom and sign score of patients,which is better than the control group[SMD=-0.41,95%CI(-0.67,-0.16),P=0.001];(3)Social function score of FDI:the treatment group can significantly reduce the social function score of FDI of patients,which is better than the control group[SMD=-0.33,95%CI(-0.58,-0.08),P=0.009<0.01];(4)Portmann scale score:the treatment group can significantly improve the Portmann scale score of patients,which is better than the control group[SMD=1.08,95%CI(0.72,1.44),P<0.00001];(5)Facial nerve function score:the treatment group can significantly improve the facial nerve function score of patients,which is superior to the control group[SMD=0.72,95%CI(0.46,0.99),P<0.00001].(2)Qualitative analysis results show that acupuncture for peripheral facial paralysis at acute stage can shorten the recovery time of patients,reduce the House-Brackmann scores,improve the FDI physical function scores,and reduce the ENo G value of facial nerve electrogram and serum Ig G,Ig A and Ig M levels,with statistically significant differences.ConclusionsAcupuncture or acupuncture combined with other therapies for the treatment of peripheral facial paralysis at acute stage has certain advantages in total effective rate,Portmann scale scores,FDI physical function scores,FDI social function scores,TCM symptoms and signs scores,facial nerve function scores,recovery time,House-Brackmann scores,ENo G value of facial nerve electrogram and serum Ig G,Ig A and Ig M levels.However,the overall quality of the included studies is not high,the number of blind trials is few,the safety and long-term efficacy of acupuncture are not evaluated,the diagnostic criteria and efficacy evaluation criteria included in the studies are different.Based on the current level of evidence,acupuncture is not highly recommended for the treatment of peripheral facial paralysis at acute stage.Therefore,in the future clinical research on this disease,we should pay attention to the evaluation of literature quality,and further carry out random control,large sample and high-quality clinical research to provide reliable clinical evidence for acupuncture peripheral facial paralysis at acute stage,thus providing reference for clinical treatment of this disease.