痛风慢性期降尿酸治疗的系统评价再评价  

Urate-lowering therapy for chronic gout: an overview of systematic reviews

作　　者：俞阳 周奇[2] 张静怡[3] 杨楠 宋霄杨[2] 高玲玲 冯映月 陈耀龙 YU Yang;ZHOU Qi;ZHANG Jingyi;YANG Nan;SONG Xiaoyang;GAO Lingling;FENG Yingyue;CHEN Yaolong(The Second Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;The First Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;School of Public Health,Lanzhou University,Lanzhou,730000,P.R.China;Evidence-based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou,730000,P.R.China;Chinese GRADE Centre,Lanzhou,730000,P.R.China;WHO Collaborating Centre for Guideline Implementation and Knowledge Translation,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学第二临床医学院,兰州730000 [2]兰州大学第一临床医学院,兰州730000 [3]兰州大学公共卫生学院,兰州730000 [4]兰州大学医学院循证医学中心,兰州730000 [5]兰州大学GRADE中国中心,兰州730000 [6]世界卫生组织指南实施与知识转化合作中心,兰州730000

出　　处：《中国循证医学杂志》2018年第12期1368-1375,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的对痛风慢性期降尿酸治疗系统评价进行再评价。方法计算机检索PubMed、EMbase、The Cochrane Library、Epistemonikos、CBM、WanFang Data和CNKI数据库,搜集公开发表的痛风慢性期降尿酸治疗的系统评价/Meta分析,检索时限均为建库至2017年4月8日。由2名研究者独立筛选文献并提取资料,采用AMSTAR工具评价纳入研究的方法学质量,并运用GRADE方法对系统评价的结局指标进行证据质量分级。结果最终纳入1 1篇系统评价/M e t a分析,所有系统评价均涉及别嘌醇, 1 0篇涉及非布司他,3篇涉及苯溴马隆,1篇涉及丙磺舒。纳入系统评价包含3个主要结局指标。10篇系统评价对纳入原始研究进行了偏倚风险评价,其中8篇使用Cochrane risk of bias偏倚评估工具,2篇使用其他评价工具。AMSTAR评价结果显示:4个系统评价评分≥9分,其余系统评价评分均≤8分。GRADE分级结果显示:20个结局指标的证据质量为低或极低,10个结局指标的证据质量为中,2个结局指标的证据质量为高。结论中等质量证据显示非布司他在血尿酸达标方面优于别嘌醇,高质量证据显示两者在急性痛风发生率方面无明显差异,高质量证据显示非布司他安全性优于别嘌醇。其他降尿酸干预措施疗效尚缺乏来源于系统评价的高质量证据支持。期待未来开展更多科学而严谨的研究,生产更多高质量证据,填补相应空白。Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs)on urate-lowering therapy (ULT)for chronic gout.Methods PubMed,EMbase,The Cochrane Library, Epistemonikos,CBM,WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating urate-lowering drugs in chronic gout from inception to April 8th 2017.Two reviewers independently screened literature,extracted data,assessed the methodological quality of included SRs using the AMSTAR tool,and assessed the quality of the body of evidence for each outcome using the GRADE approach. Results A total of 11 relevant SRs/Mets were included,containing 3 main outcome measures.All these SRs contained allopurinol.Ten SRs contained febuxostat,3 SRs contained benzbromarone and 1 SR contained probenecid.Ten SRs assessed the risk of bias of included original studies.Eight SRs used the "assessing risk of bias"tool recommended by Cochrane Collaboration for this assessment while 2 used other tools.The assessment results of AMSTAR tool showed:the scores of 4 SRs were ≥9,and the others were ≤8.GRADE results showed:the quality of the evidence of 20 outcomes was low or very low,10 outcomes was moderate and two outcomes was high.Conclusions Moderate quality evidence shows that febuxostat is beneficial in achieving target serum uric acid levels when comparing to allopurinol,and high quality evidence shows the incidence of gout flares is not significantly different between the two groups.High quality evidence also shows that the safety of febuxostat is better than allopurinol.Evidence of SRs is still insufficient to support the effectiveness and safety of other urate-lowering drugs.It is expected that more scientific and rigorous researches will be performed in the future,for which more high quality evidence will be produced to fill relevant gaps.

关 键 词：痛风 降尿酸治疗 系统评价再评价 AMSTAR工具 GRADE分级 

分 类 号：R589.7[医药卫生—内分泌]