儿童和青少年注意缺陷多动障碍临床指南的系统评价

Clinical Practice Guidelines on Attention-Deficit/Hyperactivity Disorder in Children and Adolescents:A Systematic Review

目的循证评价儿童和青少年注意缺陷多动障碍（ADHD）临床指南,比较推荐药物的异同,以期为临床使用提供参考。方法计算机检索Pub Med、EMbase、VIP、Wan Fang Data和CNKI数据,以及NGC（National Guideline Clearinghouse）、GIN（Guidelines International Network）和NICE（National Institute for Health and Clinical Excellence）网站,纳入儿童和青少年ADHD相关临床指南,检索时限均为建库至2013年12月,而后使用AGREEⅡ工具评价纳入指南的方法学质量,分析比较各指南的异同。结果 1共纳入9个指南,制定时间跨度为2004~2012年,其中美国4个、欧洲3个、英国2个。2纳入指南推荐级别为A级2个、B级7个,在AGREEⅡ各领域得分高低依次为＂清晰性＂、＂范围和目的＂、＂参与人员＂、＂应用性＂、＂制定的严谨性＂及＂编辑的独立性＂,仅在＂清晰性与可读性＂和＂范围与目的＂2个领域平均得分〉60%。3纳入指南中有3个为循证指南,其在制定的严谨性上得分居前三。4各指南推荐意见略有差别。结论不同国家或地区儿童和青少年ADHD临床指南的整体质量不高,AGREEⅡ工具6个领域23个条目评分各有高低,循证指南各领域的得分均较高。今后儿童和青少年ADHD临床指南在制定的严谨性和应用性上要加强,应注意申明利益冲突,并提倡采用循证医学方法制定指南,使用最佳证据。

Objective To systematically review the methodological quality of guidelines concerning attentiondeficit/hyperactivity disorder（ADHD） in children and adolescents, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. Methods Guidelines concerning ADHD were electronically retrieved in Pub Med, EMbase, VIP, Wan Fang Data, CNKI, NGC（National Guideline Clearinghouse）, GIN（Guidelines International Network）, NICE（National Institute for Health and Clinical Excellence） from inception to December 2013. The methodological quality of included guidelines were evaluated according to the AGREE II instrument, and the differences between recommendations were compared. Results A total of 9 guidelines concerning ADHD in children and adolescents were included, with development time ranging from 2004 to 2012. Among 9 guidelines, 4 were made by the USA, 3 in Europe and 2 by UK. The levels of recommendations were Level A for 2 guidelines, and Level B for 7 guidelines. The scores of guidelines according to the domains of AGREE II decreased from ＂clarity of presentations＂, ＂scope and purpose＂, ＂participants＂, ＂applicability＂, ＂rigour of development＂ and ＂editorial independence＂. Three evidence-based guidelines scored the top three in the domain of ＂rigour of development＂. There were slightly differences in the recommendations of different guidelines. Conclusion The overall methodological quality of ADHD guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE II vary with scores, while the scores of evidence-base guidelines are higher than those of non-evidence-based guidelines. The guidelines on ADHD in children and adolescents should be improved in ＂rigour of development＂ and ＂applicability＂ in future. Conflicts of interest should be addressed. And the guidelines are recommended to be developed on the basis of methods of evidence-based medicine, and best evidence is recommended.