服用二甲双胍的2型糖尿病患者进行碘造影剂检查的指南推荐意见质量评价  

Assessment the Recommendation of Administration of Iodinated Contrast Medium for Type 2 Diabetes Patients Receiving Metformin

作　　者：张爱玲[1] 罗旭飞 孟海阳 张晶敏[1] 李纳[1] 秦贵军[3] 鲁憬莉[1] 康建[1] 陈耀龙 张晓坚[1] ZHANG Ailing;LUO Xufei;MENG Haiyang;ZHANG Jingmin;LI Na;QIN Guijun;LU Jingli;KANG Jian;CHEN Yaolong;ZHANG Xiaojian(Department of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052 China;School of Public Health,Lanzhou University,Lanzhou 730000,China;Department of Endocrinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Evidence-based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]郑州大学第一附属医院药学部,郑州450052 [2]兰州大学公共卫生学院,兰州730000 [3]郑州大学第一附属医院内分泌及代谢科,郑州450052 [4]兰州大学基础医学院循证医学中心,兰州730000

出　　处：《医药导报》2022年第12期1804-1809,共6页Herald of Medicine

基　　金：国家自然科学基金资助项目(82073860)。

摘　　要：目的采用AGREEⅡ工具评价服用二甲双胍的2型糖尿病患者行碘造影剂检查的指南推荐意见质量,为医生的临床决策提供参考。方法计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网、万方数据库以及指南相关数据库网站,查找有关2型糖尿病患者使用二甲双胍进行碘造影剂检查的推荐意见的临床指南,检索时限从建库至2021年11月28日。由2位研究者独立筛选文献、提取资料,4位研究者采用AGREEⅡ工具评价指南质量。结果共纳入7部指南。评价结果显示,皇家澳大利亚和新西兰放射医师学院的指南总得分最高;6个领域中,得分最高的是领域四(清晰性),最低的是领域五(应用性)。纳入指南对服用二甲双胍的2型糖尿病患者进行碘造影剂检查的推荐意见不一致:对于肾小球滤过率(eGFR)>60 mL·min·(1.73 m^(2))^(-1)的患者,有6部指南明确提出检查前后无需停药,仅中国指南要求停用二甲双胍;对eGFR在30~60 mL·min·(1.73 m^(2))^(-1)的患者,指南推荐意见存在较大分歧;对eGFR<30 mL·min·(1.73 m^(2))^(-1)的患者,仅3部指南给出推荐意见。结论目前服用二甲双胍的糖尿病患者进行碘造影剂检查的停药时机的推荐意见存在分歧,而且部分指南的质量有待提高。建议指南制定者应该遵循指南制定和更新的方法学,同时加强对指南各领域,尤其是应用性领域的描述。Objective To evaluate and analyze the quality of clinical practice guidelines on the administration of iodinated contrast medium for diabetes patients receiving metformin to give clinicians suggestions.Methods Relevant guidelines on the risk of lactic acidosis after administration of iodinated contrast medium for diabetes patients receiving metformin were published until November 28,2021.They were identified from PubMed,EMbase,The Cochrane Library,CBM,CNKI,Wanfang,and websites of guidelines.Guidelines were comprehensively screened by two researchers,and evaluated based on the Appraisal of Guidelines for Research and Evaluation(AGREE)Ⅱinstrument,and data were independently extracted by four researchers.Results A total of seven guidelines were included for the quality appraisal by using the AGREEⅡinstrument.The Royal College of Radiology guidelines of Australia and New Zealand had the highest scores.Among the domains of AGREEⅡ,domains I(scope and purpose)and IV(clarity of presentation)scored the highest,with a minimum of domain V(applicability).Inconsistent recommendations for inclusion in guidelines for iodine contrast screening in patients with type 2 diabetes taking metformin.For patients with eGFR>60 mL·min·(1.73 m^(2))^(-1) receiving contrast medium,six guidelines clearly stated that there is no need to discontinue metformin.There are considerable differences in the recommendations of patients with eGFR of 30-60 mL·min·(1.73 m^(2))^(-1) in different guidelines.In the recommendations of patients with eGFR<30 mL·min·(1.73 m^(2))^(-1),only three guidelines provided recommendations.Conclusion There are significant differences in the recommendations of clinical practice guidelines on the recommendation of administration of iodinated contrast medium for diabetes patients receiving metformin.In addition,the quality of some guidelines needs to be improved.Therefore,future development of delirium guidelines should follow the methodology of guideline development,update,or adjustment and be dedicated to every

关 键 词：二甲双胍 碘造影剂 2型糖尿病 指南 乳酸酸中毒 

分 类 号：R969.3[医药卫生—药理学] R979.9[医药卫生—药学]