正确理解和应用低质量证据形成指南推荐意见  

How to Correctly Understand and Use the Low⁃quality Evidence to Formulate Recommendations in Guidelines

作　　者：史乾灵 刘辉 王子君[2,3,4,5] 罗旭飞 王冰怡 杨楠 孟文勃 陈耀龙[2,3,4,5,7,8] SHI Qianling;LIU Hui;WANG Zijun;LUO Xufei;WANG Bingyi;YANG Nan;MENG Wenbo;CHEN Yaolong(The First School of Clinical Medicine,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Research Unit of Evidence-based Evaluation and Guidelines,Chinese Academy of Medical Sciences,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Key Laboratory of Evidence-based Medicine of Gansu Province,Lanzhou 730000,China;Institute of Health Data Science,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Evidence-based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730000,China;Guidelines and Standards Research Center,Chinese Medical Association Publishing House,Lanzhou 730000,China;WHO Collaborating Center for Guideline Implementation and Knowledge Translation,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院,兰州730000 [3]甘肃省循证医学重点实验室,兰州730000 [4]兰州大学健康数据科学研究院,兰州730000 [5]兰州大学基础医学院循证医学中心,兰州730000 [6]兰州大学第一医院普外科,兰州730000 [7]中华医学会杂志社指南与标准研究中心,兰州730000 [8]世界卫生组织指南实施与知识转化合作中心,兰州730000

出　　处：《协和医学杂志》2024年第3期676-685,共10页Medical Journal of Peking Union Medical College Hospital

基　　金：中国医学科学院医学与健康科技创新工程-循证评价与指南研究创新单元(2021RU017)。

摘　　要：推荐意见是临床实践指南的核心。基于低质量证据作出强推荐意见是当前国内外指南普遍存在的现象。医务人员认为缺乏高质量的证据就无法制订高质量的指南或仅可制订专家共识是典型的误解。本文以GRADE分级系统为切入点,阐述低质量证据的基本内涵和临床作用,介绍基于低质量证据形成指南推荐意见的方法,以期为我国指南制订者和使用者提供参考。The essence of clinical practice guidelines lies in their recommendations.It is common to find strong recommendations supported by low-quality evidence in current published guidelines.There is a typical misunderstanding among medical professionals that without high-quality evidence,it is impossible to develop high-quality guidelines or only expert consensus can be developed.Based on the GRADE approach,this paper explains the concept and clinical significance of low-quality evidence,and introduces the methods for formula-ting recommendations based on low-quality evidence in guidelines,with the aim to provide reference for guide-line developers and users in China.

关 键 词：临床实践指南 推荐意见 证据质量 GRADE 

分 类 号：R181.2[医药卫生—流行病学]