Meta Analysis Of Acupuncture In The Treatment Of Chemotherapy-induced Peripheral Neuropathy

Objective:Meta-analysis is used to evaluate the clinical efficacy of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy.It was also used to explore the common acupoints and safety.The study was aimed to furnish proof for the clinical application of acupuncture to treat chemotherapy-induced peripheral neuropathy.Methods:The clinical trials of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy were searched in seven databases including CNKI,Wanfang,VIP,PubMed,Embase,Web of science and CHETRAL.The retrieved literatures were imported into endnote software.Some literatures were taken out by using the automatic duplicate checking function,and then the literatures were screened by the inclusion and exclusion criteria the criteria.The data were extracted to input into Revman 5.3 software for analysis.Results:23 documents were obtained.1210 patients were are incorporated into the study.The main outcome indicators are:Effective rate,Patient Neuropathy Questionnaire(PNQ),Oxaliplatin specific toxicity grading standard(Levi),National Cancer Institute Common Terminology Criteria for Adverse Events(NCI-CTCAE),Karnofsky(KPS),Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity(FACT/GOG-NTX),Brief Pain Inventory-Short Form(BPI-SF),Numerical Rating Scale(NRS),Visual Analogue Scale(VAS),Nerve conduction velocity(NCV).Revman 5.3 software was used for analysis.The results are as follows:1.Effective rate:In comparison with the control,the curative effect of the acupuncture group was efficient(RR=1.34,95%CI:[1.2,1.5],P<0.00001).There was no significant publication bias.2.Patient Neuropathy Questionnaire(PNQ):In general,acupuncture improved the neurological dysfunction of CIPN patients more than the control group(RR=1.57,95%CI:[1.22,2.02],P=0.0005).Subgroup analysis showed that compared with the control group,acupuncture was more effective in improving sensory nerve function,but it was not obvious in improving motor nerves(RR sensorynerve=1.55,95%CI:[1.18,2.02],P=0.002;RR motor nerve=1.7895%CI:[0.83,3.80],P=0.89).3.Levi Neurotoxicity Rating Scale:The acupuncture group reduced the neurotoxicity score compared to the control group(MD=-0.62,95%CI:[-0.9,-0.33],P<0.0001).4.NCI-CTCAE Neurotoxicity Rating Scale:Compared with the control group,the acupuncture group effectively alleviated the peripheral neurotoxicity of patients(MD=-0.4,95%CI:[-0.68,-0.11],P=0.007).5.Karnofsky(KPS):In comparison with the control,the acupuncture group improved the KPS score of patients and ameliorate lifestyle(RR=2.21,95%CI:[1.51,3.25],P<0.0001).6.FACT/GOG-NTX:Compared with the control group,the acupuncture group reduced the FACT/GOG-NTX score and ameliorate lifestyle(RR=-2.2,95%CI:[-2.41,-1.99],P<0.00001).7.BPI-SF Form:Compared with the control group,the acupuncture group reduced the BPI-SF score and the pain of CIPN,which was statistically significant(RR=-1.64,95%CI:[-1.71,-1.58],P<0.0001).8.NRS score:Acupuncture reduced the NRS pain score of patients,and it was statistically significant(MD=-1.04,95%CI:[-1.47,-0.62],P<0.00001).9.Visual Analogue Scale(VAS pain score):Acupuncture reduced the VAS pain score and relieve neurotoxic pain,with statistical significance(MD=-2.14,95%CI:[-3.42,-0.86],P=0.001).lO.Nerve conduction velocity(NCV):Acupuncture improved the conduction function of sensory nerves but not improved the conduction function of motor nerves significantly(MD sensory nerve-1.74,95%CI:[0.66,2.81],P=0.002;MD motor nerve=0.77,95%CI:[-0.44,1.99],P=0.21).Conclusion:1、Compared with chemotherapy alone or the use of neurotrophic drugs,acupuncture can improved the clinical efficacy of CIPN.2、Regardless of using the Levi scale or the NCI-CTCAE scale,acupuncture reduced the neurotoxicity grade compared to the control group.3、Whether using KPS score or FACT/GOG-NTX score,acupuncture can ameliorate the CIPN patient’s lifestyle.4、Using the three scales to reach a consistent conclusion,acupuncture significantly reduced the pain score of CIPN and relieve pain.5、Compared with the motor nerve,acupuncture can improve the conduction velocity of sensory nerve.6、The adverse reactions of acupuncture treatment are low and the safety was high.Compared with the control group,the overall curative effect is significant.However,due to the small overall sample size,large-scale clinical trials are needed to increase the credibility of the research results.7、The overall quality of the included literature was low.The situation of not paying attention to the allocation of hidden blindness needs to be further improved.