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儿童免疫性血小板减少性紫癜诊疗指南和专家共识的质量评价
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| 篇名： | 儿童免疫性血小板减少性紫癜诊疗指南和专家共识的质量评价 |
| TITLE： | Quality evaluation of diagnosis and treatment guidelines and expert consensus for children with immune thrombocytopenic purpura |
| 摘要： | 目的 对国内外发布的儿童免疫性血小板减少性紫癜（ITP）诊疗指南和专家共识的质量进行评价，以期为临床实践及今后诊疗指南/专家共识的制订和完善提供参考。方法系统检索PubMed、CochraneLibrary、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库，同时补充检索医脉通、中华医学会、英国国家卫生与临床优化研究所等网站；检索时间限定自建库至2024年9月2日。由经过系统培训的研究者采用指南研究与评价工具（第2版）（AGREEⅡ）和国际实践指南报告标准（RIGHT）独立对纳入诊疗指南/专家共识的方法学及报告质量进行评价。结果共纳入诊疗指南/专家共识11篇。AGREEⅡ工具6个领域的平均得分依次为“范围和目的”（[66.67±17.98）%]、“参与人员”[58.33%（13.89%，73.61%）]、“严谨性”（[41.81±23.85）%]“、清晰性”（[69.57±19.35）%]“、应用性”（[35.98±17.83）%]“、独立性”[27.08%（0，75.00%）]；11篇文献中9篇推荐等级为B级，2篇推荐等级为C级，无A级文献。RIGHT工具7个领域的平均报告率分别为“基本信息”（[72.35±12.95）%]、“背景”（[54.55±15.40）%]“、证据”（[36.36±24.81）%]“、推荐意见”（[53.25±19.20）%]“、评审和质量保证”[0（0，25.00%）]“、资金与利益冲突声明及管理”[12.50%（0，25.00%）]及“其他”[8.33%（0，50.00%）]。诊疗指南与专家共识在AGREEⅡ和RIGHT评分上的差异无统计学意义（P＞0.05）。结论纳入的诊疗指南和专家共识整体质量不高，推荐等级为B级或C级，建议临床决策优先参考其中相对高质量的诊疗指南/专家共识；现有的儿童ITP中医药诊疗指南的证据质量有待提高，且尚无中西医结合诊疗指南/专家共识。建议按照AGREEⅡ和RIGHT各领域要求修改或撰写相关诊疗指南/专家共识以指导临床实践。 |
| ABSTRACT： | OBJECTIVE To evaluate the quality of diagnosis and treatment guidelines and expert consensuses on childhood immune thrombocytopenic purpura （ITP） published domestically and internationally， in order to provide reference for clinical practice and future guideline/expert consensus development and improvement. METHODS A systematic search was conducted across multiple databases， including PubMed， Cochrane Library， Embase， CNKI， Wanfang data， VIP， CBM； additionally， supplementary searches were carried out on websites such as Medlive， the Chinese Medical Association’s official website， and National Institute for Health and Clinical Excellence in the UK. The retrieval time ranged from the inception to September 2， 2024. Researchers who had undergone systematic training independently evaluated the methodology and report quality included in the guideline/consensus using the Appraisal of Guidelines Research and Evaluation Ⅱ （AGREE Ⅱ） and the Reporting Items for Practice Guidelines in Healthcare （RIGHT）. RESULTS A total of 11 guidelines/consensuses were included. The average scores for the six domains of AGREE Ⅱ tool respectively were “range and purpose” （[ 66.67±17.98）% ]， “participants” [58.33% （13.89%，73.61%）]， “rigor” （[ 41.81±23.85）% ]， “clarity”（[ 69.57±19.35）%]， “applicability” （[ 35.98±17.83）%]， and “independence” [27.08% （0，75.00%）]； out of 11 articles， 9 had a recommendation level of B， 2 had a recommendation level of C， and there were no A-level articles. The average reporting rates of the 7 areas in the RIGHT tool were “basic information” （[ 72.35±12.95）% ]， “background” （[ 54.55±15.40）%]，“ evidence” （[ 36.36±24.81）%]，“ recommended opinions” （[ 53.25±19.20）%]，“ review and quality assurance” [0 （0， 25.00%）]， “funding and conflict of interest statement and management” [12.50%（0，25.00%）]， and other aspects [8.33%（0， 50.00%）]. In addition， there was no statistically significant difference in the AGREE Ⅱ and RIGHT scores between the guidelines and consensuses （P＞0.05）. CONCLUSIONS The overall quality of the guidelines and consensuses included in this study is not high， with a recommended level of B or C. It is recommended that clinical decision-making prioritize referring to the relatively high-quality guideline/consensus among them. The quality of evidence in the existing traditional Chinese medicine guidelines for children with ITP needs to be improved， and there is no integrated guideline/consensus for traditional Chinese and Western medicine. It is recommended to revise or write relevant guideline/consensus according to the requirements of AGREE Ⅱ and RIGHT in various fields to guide clinical practice. |
| 期刊： | 2025年第36卷第13期 |
| 作者： | 邢亚萍；丁樱；韩姗姗；邢文超；贾璐；童敏；任晓丹 |
| AUTHORS： | XING Yaping，DING Ying，HAN Shanshan，XING Wenchao，JIA Lu，TONG Min，REN Xiaodan |
| 关键字： | 免疫性血小板减少性紫癜；儿童；诊疗指南；专家共识；AGREE Ⅱ；RIGHT；质量评价 |
| KEYWORDS： | immune thrombocytopenic purpura； children； diagnosis and treatment guideline； expert consensus； AGREE Ⅱ； |
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