Allergic rhinitis (AR) is closely linked to local inflammation and microbiota composition in the nasopharynx. Existing mechanistic studies of acupuncture in AR have mainly addressed immune and inflammatory modulation; its effects on the pharyngeal microbiota remain largely unexplored.

To compare the clinical efficacy of acupuncture combined with acupoint plaster versus acupoint plaster alone in AR, and to characterize treatment-related changes in the oropharyngeal and nasopharyngeal microbiota.

In this single-center, open-label randomized controlled trial, 64 AR patients were recruited at the Department of Acupuncture and Moxibustion, Zhejiang Hospital (from May to November 2024) and randomized to combined treatment (acupuncture+acupoint plaster, n=32) or plaster alone (n=32). Clinical outcomes were measured with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Oropharyngeal and nasopharyngeal samples were collected pre- and post-intervention and profiled by 16S rRNA gene sequencing.

Six patients (three per group) withdrew; 29 participants per group completed the protocol. Both groups showed significant post-treatment reductions in RQLQ scores, with the combined treatment group showing greater improvement than plaster alone (P<0.01). Microbiota analyses revealed divergent responses: in the combined-treatment group, post-treatment, shared dominant oropharyngeal taxa in both groups included Rothia, Staphylococcus, skin-associated Corynebacterium, and various rod-shaped bacilli; the combined group showed an increase in short rod-shaped bacteria in the oropharynx, while the control group had increased oropharyngeal Staphylococcus (P<0.05). Nasopharyngeal communities were dominated across timepoints by Streptococcus, Clostridium, Neisseria, Prevotella, Rothia, Haemophilus, Veillonella and related taxa; after treatment, Streptococcus increased and Haemophilus decreased in both groups. Differential abundance analysis showed that bacilli, Staphylococcus, Acinetobacter and Cutibacterium were significantly more abundant in the oropharynx than the nasopharynx (P<0.001), whereas Veillonella, Neisseria, Prevotella, Haemophilus, Streptococcus and Clostridium were more abundant in the nasopharynx (P<0.001). After treatment, Rothia abundance in the nasopharynx was higher than in the oropharynx in the combined-treatment group (P<0.05). LEfSe profiling indicated an expansion of dominant taxa in the oropharynx after combined therapy (71/24 taxa), whereas plaster alone was associated with a net reduction of dominant taxa (12/41). In the nasopharynx, the combined group showed stable numbers of dominant taxa (10/10) while the control group decreased (2/14).

Both acupuncture combined with acupoint plaster and acupoint plaster alone improve clinical symptoms in AR. However, combined therapy is associated with increased oropharyngeal microbial richness and expansion of dominant taxa, whereas plaster alone tends to reduce microbial richness and dominant taxa in both oropharyngeal and nasopharyngeal niches. Distinct microbial compositions exist between the oropharynx and nasopharynx. The therapeutic effects of acupuncture combined with acupoint plaster on AR may be mediated, at least in part, by modulation of pharyngeal microbiota structure, including an increased abundance of Rothia in the nasopharynx.

变应性鼻炎（AR）的发病机制与鼻咽局部的炎症状态和菌群结构密切相关，但关于针灸治疗AR的机制研究主要集中在对免疫炎症的调节上，关于其对咽部菌群调节作用的研究很少，针刺治疗AR的疗效机制仍待研究。

探索针刺结合穴位敷贴和单纯穴位敷贴对AR的临床疗效及其对咽部菌群的影响。

本研究是一项单中心、开放、随机对照试验，以2024年5—11月浙江医院针灸科面向社会公开招募的64例AR患者为研究对象，随机分为治疗组（n=32）和对照组（n=32）。治疗组采用针刺结合穴位敷贴治疗，对照组仅采用穴位敷贴治疗，采用鼻结膜炎生活质量问卷（RQLQ）评估干预措施对AR患者鼻炎症状的改善作用，同时在治疗前后收集每位患者的口咽及鼻咽分泌物，采用16S rRNA基因测序技术检测患者口咽部和鼻咽部菌群。

治疗过程中治疗组3例退出，对照组3例退出，最终治疗组和对照组各有29例患者完成试验。治疗后两组RQLQ评分均较治疗前降低，治疗组治疗后RQLQ评分低于对照组（P<0.01）。基因测序分析结果显示，治疗后两组口咽部菌群中共同的优势细菌有劳氏菌、葡萄球菌、皮肤杆菌、棒状杆菌，治疗组口咽短杆菌增加，对照组口咽葡萄球菌增加（P<0.05）。治疗前后两组鼻咽菌群中的优势细菌基本一致，有链球菌、梭杆菌、奈瑟菌、钩端螺旋体、普氏菌、罗氏菌、嗜血杆菌和韦荣氏菌；治疗后，两组鼻咽菌群中链球菌呈增加、嗜血杆菌减少（P<0.05）。益生菌罗氏菌也被包括在鼻咽部的优势细菌中。关键物种差异分析：口咽菌群中棒杆菌、葡萄球菌、不动杆菌和切割杆菌的丰度高于鼻咽菌群（P<0.001），而鼻咽菌群中韦荣氏菌、奈瑟菌、普氏菌、嗜血杆菌、链球菌和梭杆菌的丰度高于口咽菌群（P<0.001）。治疗后，治疗组鼻咽菌群中罗氏菌的丰度高于口咽菌群（P<0.05）。线性判别分析效应量（LEfSe）分析显示，口咽菌群：治疗组治疗前有24种优势细菌、治疗后有71种优势细菌，对组治疗前有41种优势细菌、治疗后有12种优势细菌。鼻咽菌群：治疗组治疗前有10种优势细菌、治疗后有10种优势细菌，对照组治疗前有14种优势细菌、治疗后有2种优势细菌。

针刺结合敷贴疗法和单纯敷贴疗法均可改善AR患者的临床症状，但针刺结合敷贴治疗后AR患者口咽菌群的丰度、优势细菌种类显著增加，敷贴治疗后口咽和鼻咽菌群的丰度和优势细菌种类显著减少。口咽和鼻咽菌群存在差异，针刺结合敷贴疗法治疗AR的机制可能与调节口咽和鼻咽部的菌群结构有关，包括增加鼻咽中罗氏菌的丰度。