中国慢病防治指南现状分析及评价

Current status of guidelines for preventing and treating chronic non-communicable diseases in China

目的对中国慢性非传染性疾病慢病防治指南进行循证评价。方法检索维普数据库、中国知网、万方数据库以及中国生物文献数据库1978至2011年公开发表的国内慢病指南及指南相关资料,按照纳入标准筛选指南。描述性分析纳入指南的名称、发表年份、开发方法、参考文献数量等内容。采用循证医学评价临床指南的AGREE工具评价我国慢病防治的最新版临床指南的情况。结果共纳入慢病防治临床指南8部,其中基层版指南1部。8部指南在范围和目的、权益相关人员的参与情形、开发的严谨性、明确性和代表性、应用性、编辑的独立性共6个评价领域的平均得分分别为89.6%、51.8%、55.7%、85.1%、55.9%、37.5%。其中,《中国高血压防治指南》2009基层版、《中国高血压防治指南》2010年修订版、《中国2型糖尿病防治指南》2010年修订版、《中国血糖监测临床应用指南》2011年版、《中国缺血性脑卒中防治指南》2010修订版共5部指南为积极推荐指南,《慢性稳定性心绞痛诊断与治疗指南》2007年版、《慢性心力衰竭诊断治疗指南》2007年版2部指南为推荐指南。结论①我国现阶段慢病防治临床指南总体符合要求,但仍存在一些有共性的缺陷;②急需制定出符合基层实际情况的常见慢病防治指南,并建立一套科学、系统、实用的适合我国的卫生技术指南评价体系。

Objective To review the guidelines for preventing and treating chronic non-communicable diseases （NCD） in China based on evidence-based medicine （EBM）. Methods The databases of VIP Database, CNKI, WanFang Database and CBM were retrieved for collecting domestic guidelines and relative materials for NCD prevention and treatment published from 1978 to 2011, which then screened according to the inclusion criterion. The names, published years, and development methods of the guidelines and quantity of reference materials were analyzed descriptively. The status of the newest clinical guidelines for preventing and treating NCD in China was reviewed by using EBM instrument of appraisal of guidelines research and evaluation （AGREE）. Results There were totally 8 guidelines included, among them one was community version. The average scores of these 8 guidelines were, respectively, 89.6%, 51.8%, 55.7%, 85.1%, 55.9% and 37.5% in six reviews fields including guideline＇ s scope and objective, participation of right-related persons, rigor, clarity and representative, applicability and editors＇ independence. Of these 8 guidelines, the Chinese Guideline for the Management of Hypertension （2009 community version）, the Chinese Guideline for the Management of Hypertension （2010 revised version）, the Chinese Guideline for the Management of Type 2 Diabetes Mellitus （2010 revised version）, the Chinese Clinical Guideline for Glucose Mo^fitoring （2011） and the Chinese Guideline for the Management of Ischemia Stroke （2010 revised version） were positively recommended ones, and the Guideline for Diagnosis and Treatment of Chronic Stable Angina （2007） and the Guideline for Diagnosis and Treatment of Chronic Heart Failure （2007） were recommended ones. Conclusion ①The present guidelines for preventing and treating chronic NCD in China can generally meet the requirements, but there are still defects in common. ②It is badly in need to formulate the guidelines for preventing and treating common NCD in line with the real situation of grassroots, and to establish a series of scientific, systemic and practical evaluation system for our country＇ s health technology.