基于AGREEⅡ工具评价冠心病中西医临床实践指南的质量

Quality Evaluation of Traditional Chinese and Western Medicine Clinical Practice Guidelines for Coronary Heart Disease Based on AGREEⅡTool

目的基于AGREEⅡ工具评价国内冠心病临床实践指南的方法学及质量。方法计算机检索中国知网(CNKI)、维普(VIP)、万方(Wanfang Data)和中国生物医学文献数据库(CBM),收集国内冠心病临床实践指南,检索时间从建库至2019年10月。由4名研究者独立筛选文献、提取资料后,采用AGREEⅡ工具评价纳入指南的方法学质量。结果共纳入7部国内机构制订的指南或专家共识,包括急性心肌梗死中西医结合诊疗指南、冠心病稳定型心绞痛中医诊疗专家共识、冠心病心绞痛介入前后中医诊疗指南、动脉粥样硬化中西医结合诊疗专家共识、急性心肌梗死中西医结合诊疗专家共识、中医内科常见病诊疗指南(西医疾病部分)冠心病心绞痛、胸痹心痛中医诊疗指南。AGREEⅡ评价结果表明,多数指南在“范围和目的”“参与人员”“表达的清晰性”方面较完整,但“制订的严谨性”“应用性”“编辑的独立性”方面欠佳。急性心肌梗死中西医结合诊疗指南和急性心肌梗死中西医结合诊疗专家共识欠缺的两方面得分最高,其中“应用性”平均得分为46.3%,急性心肌梗死中西医结合诊疗专家共识得分最高,为59.4%,其次为急性心肌梗死中西医结合诊疗指南得分为52.1%;“编辑的独立性”方面,平均得分为47.3%,急性心肌梗死中西医诊疗指南得分最高,为75.0%,急性心肌梗死中西医结合诊疗专家共识得分次之,为62.5%。全面评价结果显示,强烈推荐使用的指南包括2个,推荐(补充或改进)的指南包括3个,不能确定是否推荐使用的指南包括2个。结论急性心肌梗死中西医结合诊疗指南和急性心肌梗死中西医结合诊疗专家共识在国内冠心病中西医临床实践指南的方法学质量均较高,可为临床诊疗提供指导性意见。

Objective To evaluate the methodology and report quality of domestic clinical practice guidelines for coronary heart disease in China based on the AGREEⅡtool.Methods China Journal Full-Text Database(CNKI),Wanfang database,and Chinese science and technology periodical database(VIP),and Chinese Biomedical Literature were searched from establishment to October 2019 and the clinical practice guidelines of coronary heart disease were collected.Four researchers independently selected literature and extracted data,and evaluated the methodological quality and reporting quality of the guidelines by AGREEⅡ.Results The guidelines or expert consensus of 7 domestic institutions were included,involving the guidelines for the integrated diagnosis and treatment of Chinese and Western medicine for acute myocardial infarction,the consensus of experts for the diagnosis and treatment of stable angina pectoris of coronary heart disease,the guidelines for the diagnosis and treatment of Chinese medicine before and after the intervention of angina pectoris of coronary heart disease,the consensus of experts for the integrated diagnosis and treatment of Chinese and western medicine for atherosclerosis,the consensus of experts for the integrated diagnosis and treatment of Chinese and western medicine for acute myocardial infarction,and disease diagnosis and treatment guide(western medicine disease part)coronary heart disease angina pectoris,chest arthralgia and heartache traditional Chinese medicine diagnosis and treatment guideline.The evaluation results of AGREEⅡshowed that most guidelines were relatively completed in terms of"scope and purpose","participants","clarity of expression",but they were less well reported in terms of"preciseness of formulation","application"and"editorial independence".But"guideline of integrated diagnosis and treatment of TCM and Western medicine"and"expert consensus of integrated diagnosis and treatment of traditional Chinese medicine and western medicine of acute myocardial infarction"scored the highest in the lack of two areas.In terms of"applicability",the average score was 46.3%,the highest consensus score of experts in integrated Chinese and Western medicine diagnosis and treatment of acute myocardial infarction was 59.4%,and the score of integrated Chinese and Western medicine diagnosis and treatment guideline of acute myocardial infarction was 52.1%.In terms of editorial independence,the average score was 47.3%,and the highest score of integrated Chinese and Western medicine diagnosis and treatment guideline of acute myocardial infarction was 75.0%.Combined with the consensus score of diagnosis and treatment experts,the second was 62.5%.Therefore,the comprehensive evaluation showed that there were two strongly recommended guidelines,three recommended(supplemented or improved)guidelines,and two guidelines were not sure whether they were recommended or not.Conclusion"integrated diagnosis and treatment guide of Chinese and western medicine"and"integrated diagnosis and treatment guide of Chinese and western medicine for acute myocardial infarction"with high methodological and report quality of Chinese and western clinical practice guidelines for coronary heart disease in China,could provide important guidance for clinicians and patients in diagnosis and treatment in the future.