2017~2019年肝病营养指南的质量评价及对比解读

Quality evaluation and comparative interpretation of guidelines on nutrition in liver disease from 2017 to 2019

目的评价2017~2019年肝病营养指南的质量并对其进行解读,以期为临床实践提供参考。方法计算机检索CNKI、VIP、WanFang Data、Medline(Ovid)、The Cochrane Library、PubMed和医脉通,搜集关于肝病营养指南的相关文献,检索时限均从2017年1月至2019年7月。由2位评价员独立筛选文献、提取资料后采用AGREE Ⅱ评价纳入指南的方法学质量,使用组内相关系数(intraclass correlation coefficients,ICC)进行一致性检验。结果最终纳入4部指南,其中中国2部,欧洲2部。4部指南在范围和目的、参与人员、制定严谨性、清晰性、应用性和独立性6个领域的平均标化得分率分别为79.17%、71.53%、78.13%、85.42%、61.98%和43.75%。中国和欧洲除蛋白质的推荐摄入量有差别外,各指南对能量及其他营养素的推荐意见较为一致。欧洲指南认为限制蛋白质摄入对肝性脑病患者不利,而我国认为严重肝性脑病患者需减少或限制蛋白质摄入。结论 4部指南质量一般,在独立性领域还需特别加强,我国目前只有肝病营养共识及终末期肝病营养指南,且质量得分低于欧洲指南。建议应尽快制定符合我国国情的肝病营养指南,为临床医生、护士和临床营养师实施肝病患者营养筛查、评估、营养治疗及后续随访管理提供参考依据。

Objectives To evaluate the quality of guidelines on nutrition in liver disease from 2017 to 2019, and to interpret these guidelines so as to provide references for clinical practice. Methods Computer-assisted literature searches in CNKI, VIP, WanFang Data, Medline(Ovid), The Cochrane Library, PubMed and Medlive databases were performed by two reviewers for guidelines on nutrition in liver disease from January 2017 to July 2019. Two reviewers extracted data and assessed the methodological quality of the included guidelines using AGREE Ⅱ, separately. Meanwhile,the intraclass correlation coefficient(ICC) was used to assess the degree of consistency. Results Four guidelines were included with 2 from China and 2 from Europe. Their average standardised scores in the 6 domains of scope and purpose,stakeholder involvement, rigour of development, clarity, applicability and independence were 79.17%, 71.53%, 78.13%,85.42%, 61.98% and 43.75%, respectively. The Chinese and European guidelines had similar recommendations for energy and other nutrients, apart from differences in recommendations for protein intake. The European guidelines considered that restricting protein intake was not beneficial for patients with hepatic encephalopathy, while the Chinese guidelines argued that patients with severe hepatic encephalopathy were required to reduce or limit their protein intake.Conclusions All 4 guidelines are of average quality and are required to be strengthened in the ’independence’domain. Currently, the only consensus on nutrition therapy for liver disease and guidelines on nutrition in end-stage liver disease are available for references in China, with lower quality scores than that of the European guidelines.Therefore, the evidence-based guidelines on nutrition in liver disease should be developed by Chinese national conditions as soon as possible to provide references for clinicians, nurses and clinical nutritionists, enableing them to implement nutrition screening, evaluation, nutritional therapy and follow-up management for patrents with liver disease.