成人艾滋病临床指南和共识的质量评价

Quality evaluation of clinical guidelines and consensus for adult AIDS

目的 评价成人艾滋病临床指南和共识的方法学质量和报告质量。方法 计算机检索PubMed、EMbase、Web of Science、CBM、WanFang Data和CNKI数据库,补充检索GIN、NICE、NGC、WHO和医脉通等临床实践指南网站,搜集成人艾滋病相关的临床指南和共识,检索时限均从建库至2021年12月。由2位评价员按照纳入与排除标准独立筛选文献和提取资料后,采用AGREE Ⅱ和RIGHT工具对纳入指南的质量进行评价。结果 共纳入成人艾滋病指南和共识17部。AGREE Ⅱ各领域平均得分分别为:范围和目的 59.48%、参与人员37.17%、严谨性30.76%、清晰性74.75%、应用性35.54%和独立性50.49%。RIGHT评价条目中报告率最高的条目为1a、1b、1c(100.00%),其次为条目3、4(94.12%),13a、13b(88.24%),7b、11a(76.47%),5(64.71%),其余条目报告率均在60%以下。亚组分析结果显示:成人艾滋病指南在AGREE Ⅱ的3个领域(表达清晰性、应用性和独立性)和RIGHT评分平均得分均高于成人艾滋病共识;基于循证医学方法制订的指南和共识在AGREE Ⅱ的5个领域(范围和目的、参与人员、严谨性、清晰性、应用性)和RIGHT评分平均得分均高于基于专家意见或综述制订的指南和共识;国外指南和共识在AGREE Ⅱ的6个领域和RIGHT评分平均得分均高于国内指南和共识。结论 目前已发表的成人艾滋病临床指南和共识的方法学质量和报告质量均偏低,尤其是我国指南和共识跟国际指南还有一定差距。建议未来指南制订者参考AGREE Ⅱ和RIGHT等国际标准,制订出高质量的指南并推广应用,更好地规范成人艾滋病的诊疗。

Objective To evaluate the methodological and reporting quality of clinical guidelines and consensus for adult AIDS. Methods Databases including PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI were electronically searched and major guideline websites such as GIN, NICE, NGC and Yimaitong were also searched to collect guidelines and consensus for adult AIDS from inception to December 2021. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. Four reviewers evaluated the methodological and reporting quality of the included guidelines and consensus by using AGREE Ⅱ and RIGHT,respectively. Results A total of 17 adult AIDS guidelines and consensus were included. The average scores of AGREE Ⅱin various domains were 59.48% for scope and purpose, 37.17% for stakeholder involvement, 30.76% for rigor of development, 74.75% for clarity of presentation, 35.54% for applicability, and 50.49% for editorial independence. The items with the highest reporting rate among the RIGHT evaluation items were 1a, 1b and 1c(100.00%), followed by 3 and4(94.12%), 13a and 13b(88.24%), 7b and 11a(76.47%), and 5(64.71%), and the remaining items were all reported below60%. Results of subgroup analysis showed that the clarity of presentation, applicability and editorial independence of the guidelines for adult AIDS expressed in AGREE Ⅱ and the average score of RIGHT were higher than those of the consensuses for adult AIDS;the average scores of guidelines and consensuses based on evidence-based medicine in five domains of AGREE Ⅱ(scope and purpose, stakeholder involvement, rigor of development, clarity of presentation and applicability) and RIGHT were higher than those based on expert opinions or reviews. The foreign guidelines and consensus had higher average scores in the six domains of AGREE Ⅱ and the RIGHT score than the domestic guidelines.Conclusion The methodological quality and reporting quality of the published clinical guidelines and consensuses for adult AIDS is low;in particular, there is a certain gap between the national and international guidelines and consensuses.It is suggested that future guideline developers should refer to international standards, such as AGREE Ⅱ and RIGHT,formulate high-quality guidelines and promote their application to better regulate the diagnosis and treatment of adult AIDS.