中药灌肠治疗溃疡性结肠炎指南共识质量评价与内容分析

Quality evaluation and content analysis of guidelines/consensus on traditional Chinese medicine enema for ulcerative colitis

目的评价中药灌肠治疗溃疡性结肠炎(ulcerative colitis,UC)临床实践指南(clinical practice guidelines,CPGs)和专家共识的质量,并对推荐的中药灌肠方案进行内容一致性分析。方法检索主要中英文数据库和医脉通、SIGN、NICE、WHO等指南网站及数据库,检索时限为建库至2023年11月1日。汇总分析中药灌肠相关推荐内容,并采用AGREE-China、RIGHT和JBI工具分别评价CPGs和专家共识的质量。结果最终纳入2部CPGs和5部专家共识。内容分析结果表明:各CPGs和专家共识中中药灌肠推荐意见存在不一致,未详细报告证据等级和推荐强度。结肠宁、锡类散和康复新液以及血竭、复方黄柏、青黛、乌梅和三七等是不同CPGs和共识中推荐频率相对较高的方剂和中药。AGREE-China 5个领域的总得分(报告率)分别为:(62.86±29.82)分、(76.07±23.29)分、(30.00±31.74)分、(85.24±17.53)分和(14.29±34.99)分。其中,4篇强推荐、2篇弱推荐和1篇不推荐。RIGHT评价结果显示:CPGs报告项目占45.71%、未报告占44.29%、部分报告(不适用)占10.00%。JBI评价结果显示:专家共识整体质量较高。结论我国中药灌肠治疗UC相关CPGs和共识整体方法学质量有待进一步加强,不同CPG和共识中药灌肠治疗UC相关推荐内容不全面且证据基础不足。期待后期国内研究者整合现有CPG和共识证据,制定全面规范的本土化中药灌肠治疗UC的循证指南,提高适用性,正确指导临床和护理合理选择灌肠中药,发挥中药灌肠疗护UC的特色优势。

Objective To evaluate the quality of clinical practice guidelines(CPGs)and expert consensus on the treatment of ulcerative colitis(UC)with traditional Chinese medicine(TCM)enema,and to analyze the content consistency of the recommended TCM enema regimen.Methods Major Chinese and English databases and guideline websites and databases such as Yimaitong,SIGN,NICE,and WHO were searched,and the search time limit was from the establishment of data to November 1,2023.Results A total of 2 CPGs and 5 expert consents were finally included.The results of content analysis showed that there were inconsistencies in the recommendations of TCM enema among CPGs and expert consensus,and the evidence level and recommendation strength were not reported in detail.Jiechangning,Xilei powder,and Kangfuxin liquid,and Xuejie,compound Huangbai,Qingdai,Wumei,and Panax notoginseng were prescription and traditional Chinese medicine recommended by different CPGs and consensus with relatively high frequency.The total scores(reporting rate)of the 5 domains of AGREE-China were(62.86±29.82)points,(76.07±23.29)points,(30.00±31.74)points,(85.24±17.53)points,and(14.29±34.99)points.Among them,4 articles were strongly recommended,2 articles were weakly recommended,and 1 article was not recommended;The results of RIGHT evaluation showed that the items reported by CPGs accounted for 45.71%,44.29%were not reported,and 10.00%were partially reported(not applicable);JBI evaluation results showed that the overall quality of expert consensus was high.Conclusions The overall methodological quality of CPGs and consensus related to TCM enema for the treatment of UC in China should be further strengthened,and the recommendation contents of different CPG S and consensus on TCM enema for the treatment of UC are not comprehensive and the evidence base is insufficient.It is expected that domestic researchers will integrate the existing CPGs and consensus evidence and formulate a comprehensive and standardized evidence-based guideline for the treatment of UC with local traditional Chinese medicine enema in the future,so as to improve the applicability,correctly guide the clinical and nursing care to choose TCM enema,and give full play to the characteristics and advantages of TCM enema in the treatment of UC.