痛风急性发作治疗的系统评价再评价

Treatment for acute flares of gout: an overview of systematic reviews

目的评价痛风急性发作治疗相关系统评价的方法学质量及结论的可靠程度。方法计算机检索PubMed、EMbase、The Cochrane Library、Epistemonikos、CBM、WangFang Data和CNKI数据库,搜集公开发表的药物干预治疗痛风急性发作的系统评价/Meta分析,检索时限均为建库至2017年4月8日。由2名研究者独立筛选文献并提取资料,采用AMSTAR工具评价纳入研究的方法学质量,并运用GRADE方法对系统评价的结局指标重新进行证据质量分级。结果最终纳入7个系统评价/Meta分析,4个涉及非甾体抗炎药物,3个涉及秋水仙碱,2个涉及激素。纳入系统评价包含3个主要结局指标。所有系统评价均对纳入原始研究进行了方法学质量评价,其中2个使用Jadad或改良Jadad量表,其余均使用Cochrane协作网的RCT偏倚风险评估工具。AMSTAR评价结果显示:纳入的3个系统评价方法学质量属于高质量(评分≥9),4个为中等质量。GRADE分级结果显示:11个结局指标的证据质量为低或极低,5个结局指标的证据质量为中。结论现有证据显示痛风急性发作药物治疗的疗效和安全性是明确的,但尚不能对药物干预进行优先级排序,期待制作和更新相关系统评价,以综合最新证据全面比较各药物干预措施优劣。另外,尚需投入更多精力开展高质量原始研究,以填补相关领域的空白和提高证据质量水平。

Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews（SRs） on the treatment for acute gout. Methods PubMed, EMbase, The Cochrane Library, Epistemonikos, CBM,WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and metaanalyses evaluating drug interventions therapy in acute gout from inception to April 8 th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach. Results A total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal antiinflammatory drugs（NSAIDS）, three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed r isk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the ＂assessing risk of bias＂ tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that： three SRs were considered high quality（scores≥9）, and the other four were considered moderate quality. GRADE results showed： the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate. Conclusions The current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.