基于AGREE Ⅱ对糖皮质激素性骨质疏松防治与管理指南的评价  

Evaluation on guidelines for prevention and management of glucocorticoid-induced osteoporosis based on AGREE Ⅱ

作　　者：巫雅萍 张利娟 陶凤来[1] WU Yaping;ZHANG Lijuan;TAO Fenglai(Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025 China)

机构地区：[1]上海交通大学医学院附属瑞金医院

出　　处：《护理研究》2019年第15期2557-2562,共6页Chinese Nursing Research

基　　金：上海市教委护理高原学科建设项目,编号:hlgy16022kygg;上海交通大学医学院科技基金项目,编号:JYHZ1917

摘　　要：[目的]对目前已发表的糖皮质激素性骨质疏松(GIOP)临床实践指南质量进行评价,比较指南推荐意见,为糖皮质激素性骨质疏松防治与护理的临床实践与管理提供参考和借鉴。[方法]计算机检索2008年—2017年Cochrane Library、JBI、MedLine、EMbase以及万方、中国知网等中英文数据库和相关指南网站,筛选公开发表的糖皮质激素性骨质疏松防治与管理相关的临床指南,按照国际公认的指南评价工具(AGREEⅡ)分析纳入指南的方法学质量,使用组内相关系数(ICC)进行评价员间一致性检验,并进行指南推荐意见的内容分析。[结果]共纳入4篇指南,分别来自中国、日本、法国和美国,指南的总体质量较高,A级1篇,B级3篇。AGREEⅡ6个领域平均得分依次为范围和目的(92.36%)、参与人员(86.81%)、严谨性(89.35%)、清晰性(91.67%)、应用性(41.67%)和独立性(68.75%)。指南的推荐意见较为一致但仍存在一定的差异。[结论]糖皮质激素性骨质疏松防治与管理指南在应用性和独立性方面需加强和重视;提倡使用循证指南的最佳证据,但应考虑具体国情,推荐意见实践应慎重;应在借鉴国外高质量指南的基础上根据我国国情进行本土化循证指南的制定和更新,以指导临床实践。Objective:To evaluate the quality of clinical practice guidelines for glucocorticoid-induced osteoporosis(GIOP)published so far,and compare the recommendations in the guidelines,so as to provide reference for clinical practice and management of prevention and treatment of GIOP.Methods:Computer retrieval of Chinese and English databases and related Guideline websites such as Cochrane Library,JBI,MedLine,EMbase,National Guideline clearinghouse,Guidelines International Network,Wanfang,CNKI published in 2008—2017.The published clinical guidelines related to the prevention and management of GIOP were screened,and the methodological qualities of the included guidelines were analyzed,according to the internationally recognized guideline evaluation tool(AGREE II).The intra-group correlation coefficient(ICC)was used for the consistency test among evaluators,and the content analysis of the guideline recommendations was conducted.Results:A total of 4 guidelines were included,which were from China,Japan,France and the United States,respectively.The overall quality of the guidelines was high,with 1 of grade A and 3 of grade B.The average scores in the six areas of AGREEⅡwere range and purpose(92.36%),participants(86.81%),preciseness(89.35%),clarity(91.67%),applicability(41.67%)and independence(68.75%).The recommendations of the guidelines were relatively consistent,but there were still some differences.Conclusion:The guidelines for the prevention and management of GIOP need to be strengthened and emphasized in terms of applicability and independence.The best evidence of evidence-based guidelines should be advocated,but the specific national conditions should be considered,and the recommended practice should be cautious.In order to guide clinical practice,we should draw lessons from foreign high-quality guidelines and update the local evidence-based guidelines according to national situation.

关 键 词：糖皮质激素性骨质疏松 指南 临床实践 评价 循证 一致性 最佳证据 

分 类 号：R47[医药卫生—护理学]