妊娠期和产后甲状腺疾病诊治指南的质量评价及推荐意见差异分析  

Appraisal of Quality and Analysis of Recommendation Differences of Guidelines on Diagnosis and Therapy of Thyroid Disease During Pregnancy and Postpartum

作　　者：张淼 焦雪峰[1,2,4,5] 卫蔷 陈婧婧 李海龙[1,2,4,5] 曾力楠 张力 张伶俐[1,2,4,5,7] ZHANG Miao;JIAO Xuefeng;WEI Qiang;CHEN Jingjing;LI Hailong;ZENG Linan;ZHANG Li;ZHANG Lingli(Department of Pharmacy,West China Second University Hospital,Sichuan University,Sichuan Chengdu 610041,China;Evidence-based Pharmacy Center,West China Second University Hospital,Sichuan University,Sichuan Chengdu 610041,China;Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University,Sichuan Chengdu 610041,China;National Medical Products Administration(NMPA)Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation,Sichuan Chengdu 610041,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children,Sichuan University,Ministry of Education,Sichuan Chengdu 610041,China;West China School of Pharmacy,Sichuan University,Sichuan Chengdu 610041,China;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Sichuan Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院药学部,四川成都610041 [2]四川大学华西第二医院循证药学中心,四川成都610041 [3]四川大学华西第二医院妇产科,四川成都610041 [4]国家药品监督管理局药物制剂体内外相关性技术研究重点实验室,四川成都610041 [5]出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041 [6]四川大学华西药学院,四川成都610041 [7]四川大学华西医院中国循证医学中心,四川成都610041

出　　处：《中国医药导刊》2024年第8期820-827,共8页Chinese Journal of Medicinal Guide

基　　金：国家卫生健康委员会医管中心(医管中心标准管理处[2022]047号);四川省自然科学基金(2022NSFSC0644)。

摘　　要：目的:对国内外妊娠期和产后甲状腺疾病诊治指南进行质量评价,并对指南推荐意见差异进行总结,旨在为今后相关指南的制定提供参考。方法:计算机检索PubMed、Embase、Web of Science、VIP、CNKI、万方数据库及国内外相关指南数据库,搜集妊娠期和产后甲状腺疾病诊治相关的临床实践指南,检索时限均从建库至2023年10月。由2名研究者独立筛选文献、提取资料,4名研究者运用AGREEⅡ工具对纳入的指南进行质量评价,并对指南推荐意见进行比较。结果:共纳入14部指南。6个领域的AGREEⅡ评分中位数依次为:范围和目的(86.11%)、参与人员(49.31%)、严谨性(45.05%)、清晰性(70.14%)、应用性(42.71%)、独立性(46.88%)。推荐级别为:A级(推荐)5部,B级(修改完善后推荐)5部,C级(不推荐)4部。指南推荐意见差异主要为妊娠期亚临床甲状腺功能减退症和甲状腺自身抗体阳性的诊断标准和药物治疗推荐意见。结论:妊娠期和产后甲状腺疾病诊治指南在严谨性、应用性、独立性方面需进一步完善。Objective:To evaluate the methodological quality of domestic and foreign guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum,and summarize the differences of guideline recommendations,to provide reference for the for‐mulation of guidelines in the future.Methods:PubMed,Embase,Web of Science,VIP,CNKI,Wanfang database,and relevant domes‐tic and foreign guideline websites were searched to collect guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum from inception to October 2023.2 reviewers independently screened literature,extracted data,and 4 reviewers indepen‐dently used AGREE II to evaluate the quality of the included guidelines,and summarize the differences of guideline recommendations.Results:A total of 14 guidelines were included.The median scores for the 6 fields of AGREE II were:scope and purpose(86.11%),stakeholder involvement(49.31%),rigor of development(45.05%),clarity of presentation(70.14%),applicability(42.71%),and editorial independence(46.88%).The recommended levels were:A level(recommended)5,B level(recommended with modification)5,C level(not recommended)4.The inconsistencies in these guideline recommendations mainly focused on the diagnostic criteria and medications for subclinical hypothyroidism(SCH)during pregnancy and euthyroid pregnant women with thyroid autoimmunity.Conclu-sion:Guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum should be further improved in terms of rigor of development,applicability,and editorial independence.

关 键 词：甲状腺疾病 妊娠期和产后 指南 质量评价 AGREEⅡ 

分 类 号：R95[医药卫生—药学]