A Network Meta-analysis Of Acupuncture And Moxibustion For Alzheimer's Disease(AD) And Discussion On The Principles Of Acupoints

ObjectiveThe new statistical method of network meta-analysis was used to evaluate the effective rate,Mini-Mental State Examination(MMSE),activities of daily living(ADL)and Hasegawa Dementia Scale Revised(HDS-R)of patients with Alzheimer's disease treated by acupuncture and moxibustion,so as to provide a better evidence-based basis for clinical practice.At the same time,cluster analysis method was used to study the rule of acupuncture acupoint selection and moxibustion intervention in the treatment of Alzheimer' s disease.MethodSources of literature retrieval used were:computer retrieval databases CNKI,CBM,VIP,Wangfang,Pubmed,Embase and Chorane Library.All database sources are up to August 2019.The Chinese searches used were as follows:(AB=acupuncture OR AB=acupuncture OR AB=electro-acupuncture OR AB=floating needle OR AB=acupuncture OR AB =moxibustion OR AB=warm needle OR AB=ear acupoint OR AB=ear acupoint OR AB=acupoint injection OR AB=cupping OR AB=warm needle)AND(AB=alzheimer' s disease OR AB=neurocognitive impairment OR AB=alzheimer's disease OR AB=warm needle in Alzheimer' s disease),AND(AB=random OR AB=randomized OR AB=grouped OR AB=grouped OR AB=grouped OR AB=controlled)NOT(TI=rat OR TI=mouse OR TI=monkey)(CNKI as an example);in English,the search formulae were(Pubmed as an example):(Pharmacopuncture[Title/Abstract]OR Acupuncture Treatment[Title/Extract]OR Acupuncture Treatments[Title/Abstract]OR Treatment,Acupuncture[Title/Abstract],OR Therapy,Acupuncture[Title/Abstract],OR Pharmacoacupuncture Treatment[Title/Abstract],OR Treatment,Pharmacoacupuncture[Title/Abstract],OR Pharmacoacupuncture Therapy[Title/Abstract],OR Therapy,Pharmacoacupuncture Structure[Title/Abstract]OR Acupotomy[Title/Abstract]OR Acupotomies[Title/Abstract]OR moxibustion[Title/Abstract]OR warm needle[Title/Abstract]OR Temperature Needle[Title/Abstract]OR Auricular Point Sticking[Title/abstract]OR points,auricular acupuncture[Title/Abstract]OR Fire-needle therapy[Title/Abstract]OR needle warming therapy[Title/Abstract])AND(Alzheimer disease[Title/abstract]OR AD[Title/abstract]OR Dementia,Senile[Title/abstract],Senior OR Dementia,Alzheimer Type[Title/Extract],OR Senile Dementia Primary Senile Degenerative Dementia[Title/abstract],OR Alzheimer Sclerosis[Title/abstract],OR Alzheimer Syndrome[Title/abstract],OR Alzheimer Dementia[Title/abstract],OR Senile Dementia,Alzheimer Type[Title/abstract],OR Senile Dementia,Acute Confusional[Title/Abstract],OR Alzheimer Dementia[Title/Abstrcact]OR Presenile Dementia[Title/Abstract],OR Alzheimer Disease,Late Onset[Title/Abstract]).According to the criteria of inclusion and exclusion,the members of the project draw up a data extraction table to extract the following contents:title of the paper,first author,year of publication,sample size of each case,intervention measures,age,course of treatment,follow-up time,relevant items of literature quality evaluation and relevant outcomes of clinical efficacy,performance measuresand related acupoints.Data were extracted from the outcome indicators of the literature included in the study.STATA 14.0 was used for data statistics.MMSE,ADL and HDS-R were evaluated as continuous variables by this mesh meta-analysis.Weighted Mean Difference(WMD)was used as effect variable after treatment of the corresponding indicators,and 95%credibility interval(cred interval)of WMD was calculated.Confidence interval(CI)is measured by counting data and calculating odds ratio(OR)is used as the effect scale of statistical data,and 95%confidence interval(CI)of OR is calculated.This study will use Cochrane Handbook 5.1.0 risk bias method to evaluate literature quality.STATA 14.0 software was used to draw the network evidence relationship map,forest map,grade probability map,funnel map and corresponding statistics.The node-splitting method was used to check the consistency.If there was no significant difference(P>0.05),and the results of direct and indirect comparison were consistent,and STATA 14.0 is used to check the consistency showed a closed-loop.Then SUCRA was used to calculate the cumulative ranking probability of each treatment.The greater the value of SUCRA,the better the effect of the intervention.As for the research on the law of acupoint selection in literature,the research sources and methods used are CNKI,CBM,VIP,Wangfang,Pubmed,Embase and Chorane Library.According to the inclusion and exclusion criteria mentioned in this study,the relevant information eventually included in the literature is extracted and preprocessed,and the acupoints of Alzheimer' s disease are established.Prescription database,using SPSS 17.0 cluster analysis was used to get the clinical acupoint selection rules of acupuncture and moxibustion treatment of Alzheimer' s disease.Results:A total of 1629 relevant literatures were obtained in the preliminary examination,including Pubmed(n=45),Embase(n=64),Cochrane Library(n=375),CNKI(n=263),CBM(n=403),WanFang Data(n=299),VIP(n=180),manual search sources(n=20),310 articles were included after reading the titles and abstracts,and excluding duplicated documents and strictly following them.According to the criteria and exclusion criteria,67 RCTs were included in this study,totaling 4806 patients.The overall quality of 67 RCTs included in this reticular meta-analysis was acceptable,with 5 English literary sources.Twenty-three studies correctly carried out,and described in detail the generation of random sequences.Two papers did not carry out the blind method,which was high risk.Other studies only mentioned random method but did not describe the method of randomisation.One literature described in detail the use and measurement of blind method,while the other did not mention it.Regarding selective report evaluation,two literature articles mentioned the need to report ADL indicators in its design,but there is no report in the literature for which there is a risk of selective report,the rest are low risk.Whether there is incomplete data and other bias risk,as far as insurance is concerned,the bias risk of 67 RCTs is relatively low.The results of reticular meta-analysis showed that the order of SUCRA value in improving the efficiency of treating Alzheimer's disease was:warming acupuncture(86.1%)>warming acupuncture+western medicine(82.50%)>electro-acupuncture+Traditional Chinese Medicine(TCM)(75.9%)>acupuncture+western medicine(75.7%)>ear point+TCM(70.5%)>acupuncture+traditional Chinese medicine(60.3%)>acupuncture+TCM(59.6%?electricity.Acupuncture+TCM+western medicine(55%)>fire needle + western medicine(53.2%)>electro-acupuncture(33.3%)>moxibustion+TCM+western medicine(28.5%?electro-acupuncture+western medicine(27.8%?TCM(21.4%)>acupuncture(12%)>western medicine(8.2%);in improving the MMSE score of Alzheimer' s disease,the order of SUCRA value was:electro+TCM(93.4%)>Gun Acupuncture+western medicine.(90.9%)>warm acupuncture and moxibustion+Western medicine(74.2%)>Acupuncture+TCM+Western medicine(66%)>Electro-Acupuncture+Western medicine(65.8%)>Acupuncture+TCM(60.4%)>Acupuncture + TCM(47.3%?Ear Point+TCM(46.2%?Electro Acupuncture(39.6%)>Moxibustion+TCM+Western medicine(35%)>Western medicine(17.6%)>Acupuncture(9.4%)>TCM(4.3%);In terms of improving ADL score of Alzheimer's disease,TCM(94%)>electro-acupuncture+TCM(73.8%)>acupuncture+TCM(59.9%)>western medicine(58.5%)>acupuncture(58.2%)>acupuncture+western medicine(56.3%)>acupuncture+TCM + western medicine(50.3%)>electro-acupuncture(47.7%)>fire needle+western medicine(41.3%)>ear acupoint+TCM(33.9%)>electro+Traditional Chinese Medicine+Western Medicine(33.3%)>Electroacupuncture+Western Medicine(32.5%)>Warm Acupuncture and Moxibustion(10.3%);In improving the HDS-R score of Alzheimer's Disease:warm acupuncture and moxibustion(92.4%)>Electroacupuncture+TCM+Western medicine(82.4%)>Acupuncture + Western medicine(69.6%)>Electroacupuncture+Western medicine(69.0%)>Acupuncture+TCM(38.9%)>Western medicine(37.5%)>Electroacupuncture(33.8%).)Acupuncture(26.0%)and TCM(0.3%).SPSS 17.0 statistical software was used to cluster the acupoints with frequency greater than or equal to 4.Twenty-five acupoints were divided into four categories,including Baihui,Zusanli and Sishencong.The fourth category was divided into five sub-categories,namely "Neiguan-Sanyinjiao","Dazhong-Xuanzhong-Taixi","Temporal-Brain-Three Needles-Zhi".Three needles"Renzhong-Yintang-Fengchi-Xuehai-Zhongwan-Hegu-Fenglong-Fengfu-Fengchi-Mingmen-Yongquan-Shenting-Shenyu","Shenmen" and "Dazhui"are in one category.Conclusion:1.According to SUCRA probability ranking results of reticular meta-analysis,the top five treatment groups most effective in:1)improving the effective rate of treatment of Alzheimer' s disease were warm acupuncture,warm acupuncture+western medicine,electro-acupuncture+TCM,acupuncture+western medicine,ear acupoint+TCM;2)in improving the MMSE score of treatment of Alzheimer' s disease were acupuncture+TCM,fire needle+western medicine,warm acupuncture+western medicine,acupuncture + TCM + western medicine,electro-acupuncture+western medicine;3)in improving ADL score in treatment groups were:traditional Chinese medicine,electro-acupuncture+traditional Chinese medicine,acupuncture+traditional Chinese medicine,western medicine and acupuncture;4)in improving HDS-R score of Alzheimer' s disease were warming acupuncture,electro-acupuncture+TCM+western medicine,acupuncture+western medicine,electro-acupuncture+western medicine,acupuncture + TCM.2.According to the frequency analysis and cluster analysis results,the main acupoints for the treatment of Alzheimer's disease are Baihui,Sishencong,Zusanli,Taixi,Neiguan and Sanyinjiao.The single application or combination of acupoints is Baihui,Sishencong,Zusanli,Temporal-Brain-Brain-Zhisan and Xuehai-Zhongwan.