摘要
目的:对国内外妊娠期和产后甲状腺疾病诊治指南进行质量评价,并对指南推荐意见差异进行总结,旨在为今后相关指南的制定提供参考.方法:计算机检索PubMed、Embase、Web of Science、VIP、CNKI、万方数据库及国内外相关指南数据库,搜集妊娠期和产后甲状腺疾病诊治相关的临床实践指南,检索时限均从建库至2023年10月.由2名研究者独立筛选文献、提取资料,4名研究者运用AGREE Ⅱ工具对纳入的指南进行质量评价,并对指南推荐意见进行比较.结果:共纳入14部指南.6个领域的AGREE Ⅱ评分中位数依次为:范围和目的(86.11％)、参与人员(49.31％)、严谨性(45.05％)、清晰性(70.14％)、应用性(42.71％)、独立性(46.88％).推荐级别为:A级(推荐)5部,B级(修改完善后推荐)5部,C级(不推荐)4部.指南推荐意见差异主要为妊娠期亚临床甲状腺功能减退症和甲状腺自身抗体阳性的诊断标准和药物治疗推荐意见.结论:妊娠期和产后甲状腺疾病诊治指南在严谨性、应用性、独立性方面需进一步完善.
Abstract
Objective:To evaluate the methodological quality of domestic and foreign guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum,and summarize the differences of guideline recommendations,to provide reference for the for-mulation of guidelines in the future.Methods:PubMed,Embase,Web of Science,VIP,CNKI,Wanfang database,and relevant domes-tic and foreign guideline websites were searched to collect guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum from inception to October 2023. 2 reviewers independently screened literature,extracted data,and 4 reviewers indepen-dently used AGREE Ⅱ to evaluate the quality of the included guidelines,and summarize the differences of guideline recommendations. Results:A total of 14 guidelines were included. The median scores for the 6 fields of AGREE Ⅱ were:scope and purpose (86.11％),stakeholder involvement (49.31％),rigor of development (45.05％),clarity of presentation (70.14％),applicability (42.71％),and editorial independence (46.88％). The recommended levels were:A level (recommended) 5,B level (recommended with modification) 5,C level (not recommended) 4. The inconsistencies in these guideline recommendations mainly focused on the diagnostic criteria and medications for subclinical hypothyroidism (SCH) during pregnancy and euthyroid pregnant women with thyroid autoimmunity. Conclu-sion:Guidelines on diagnosis and therapy of thyroid diseases during pregnancy and postpartum should be further improved in terms of rigor of development,applicability,and editorial independence.
维普
万方数据