Meta-analysis and GRADE Evidence Quality Evaluation of Fire Acupuncture in the Treatment of Neurodermatitis
Objective To evaluate the clinical efficacy of fire acupuncture in the treatment of neurodermatitis using Meta-analysis system.Methods Chinese and English databases including CNKI,VIP,WanFang,CBM,Pubmed,and Cochrane Library were searched from their inception to February 28,2023,for randomized controlled trials(RCTs)related to fire needling in the treatment of neurodermatitis.The Cochrane risk of bias assessment tool was used to assess the quality of the included studies.Meta-analysis was performed using Revman 5.4 software,and trial sequential analysis(TSA)was conducted using TSA 0.9.5.10 software.The evidence quality of the primary outcome measures was assessed using GRADE software.Results ① A total of 18 studies involving 1662 patients,with 840 in the fire needling group and 822 in the control group,were included.② The results of the meta-analysis showed that the clinical effective rate[OR=3.99,95% CI(2.81,5.68),Z=7.71,P＜0.00 001]and recurrence rate[OR=0.27,95% CI(0.11,0.68),Z=2.79,P=0.005]in the fire needling group were superior to those in the control group.In terms of symptom score[MD=-1.49,95% CI(-2.25,-0.73),Z=3.85,P=0.0 001],TNF-α level[MD=-4.26,95% CI(-7.01,-1.51),Z=3.03,P=0.002],IL-6 level[MD=-7.39,95% CI(-14.36,-0.42),Z=2.08,P=0.04],and IL-4 level[MD=-1.50,95% CI(-1.94,-1.06),Z=6.69,P＜0.00 0001],the fire needling group was lower than the control group.③ The overall rate of adverse reactions in the fire needling group was lower than that in the control group.④ The trial sequential analysis showed that the cumulative Z-curve crossed the conventional and TSA boundaries,indicating that although the cumulative information did not reach the required sample size,further trials were not necessary,and a definitive conclusion could be made with reliable results.Conclusion Fire needling has clear therapeutic effects in the treatment of neurodermatitis,with superior effects in symptom score,TNF-α level,IL-6 level,and IL-4 level compared to the control group.It also exhibits a higher safety profile,providing relevant evidence for the effectiveness of traditional Chinese external therapy in the treatment of neurodermatitis.However,the evidence quality assessed by GRADE was not ideal.It is recommended that future researchers reduce the number of low-quality trials on fire needling in the treatment of neurodermatitis and conduct multicenter,high-quality studies to further validate the results,thereby avoiding the waste of research and medical resources.
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