目的 系统评价细菌性阴道炎(bacterial vaginosis, BV)治疗相关指南现状及质量, 比较推荐治疗方法的异同, 为临床提供依据。方法 计算机检索PubMed、Embase、中国知网(CNKI)、万方数据库、维普数据库(VIP) 、美国国国家指南文库(national guideline clearinghouse, NGC) 、国际指南联盟(guidelines international network,GIN) 等中英文数据库和相关网站(从2011年1月1日至2020年4月27日), 纳入相关细菌性阴道炎治疗指南。采用AGREE Ⅱ 工具对纳入的细菌性阴道炎实践指南进行方法学质量评价, 评价内容包括范围和目的、参与人员、制定的严谨性、表达的明晰性、应用型、编辑的独立性及总体评价。结果 共纳入7篇细菌性阴道炎治疗指南,分别来自美国、欧洲、加拿大、中国。发表年度从2011年至2020年,7篇指南中,6篇为循证指南,2篇采用GRADE证据分级系统,2篇采用CTFPHC分级标准,2篇采用USPSTF分级标准,其余1篇为非循证指南。各指南推荐治疗药物无较大区别。纳入7篇临床指南在表达的明晰性领域得分最高,为88.5%;参与人员领域分数最低,为31.3%;其中,6篇国外指南综合推荐均为B级,国内指南为C级。结论 纳入的细菌性阴道炎治疗指南质量参差不齐,得分最高的为美国疾控中心2015年发布的指南,国内指南整体质量较差,存在方法学不规范、利益冲突不声明等硬伤,指南制定较陈旧,亟需制定国内高质量的循证细菌性阴道炎药物治疗指南。
Abstract
OBJECTIVE To systematically review the quality and the status on medication therapy of the relevant guidelines for bacterial vaginosis, compare the similarities and differences of the recommended treatments, provide the basis for the clinicians. METHODS Databases such as the PubMed, Embase, CNKI, VIP, National Guideline Clearinghouse, Guidelines International Network and others databases were searched to collect guidelines on medication therapy from January 1st, 2011 to April 27st, 2020. The methodological quality of guidelines was evaluated according to Appraisal of Guidelines for Research for Research and Evaluation (AGREE Ⅱ). The AGREE Ⅱ evaluation system include scope and purpose, stakeholders′ involvement, the rigor of development, clarity of presentation, applicability and editorial independence. RESULTS A total of 7 guidelines for bacterial vaginosis were included from the United States, Europe, Canada and China, with publishing time ranging from 2011 to 2020. Among 7 guidelines, 6 were evidence-based guidelines, 2 used the GRADE evidence classification system, 2 used the CTFPHC classification standard, 2 used the USPSTF classification standard, and the remaining 1 was a non-evidence-based guideline. The treatment drugs recommended by guidelines were similar. Among the 7 clinical guidelines include, the highest score in the field of clarity of expression was 88.5%, while the lowest was 31.3% of stakeholders′ involvement. The comprehensive recommendations of the 6 foreign guides were all B-level, while the quality of domestic guideline was poor, which was C-level. CONCLUSION The quality of the included bacterial vaginosis treatment guidelines was uneven. The highest score was the guideline issued by the US Centers for Disease Control and Prevention in 2015. The overall quality of the domestic guidelines war poor. There were flaws such as methodological irregularities and conflicts of interest. Urgent need to develop new domestic high-quality evidence-based drug treatment guidelines for bacterial vaginosis.
关键词
细菌性阴道炎 /
临床实践指南 /
AGREE Ⅱ评价工具
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Key words
bacterial vaginosis /
clinical practice guidelines /
assessment tool of AGREE Ⅱ
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中图分类号：
R969.3
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参考文献
[1] KENYON C, COLEBUNDERS R, CRUCITTI T. The global epidemiology of bacterial vaginosis: a systematic review[J]. Am J Obstet Gynecol, 2013, 209(6): 505-523.
[2] MORRIS M, NICOLL A, SIMMS I, et al. Bacterial vaginosis: a public health review[J]. BJOG, 2001, 108(5): 439-450.
[3] COUDRAY M S, MADHIVANAN P. Bacterial vaginosis-A brief synopsis of the literature[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 245: 143-148.
[4] CHEN Y L, ZHOU Q, CUI R R, et al. Quality evaluation of traditional Chinese medicine guidelines based on AGREE Ⅱ instrument[J]. Chin J Evid-Based Med(中国循证医学), 2016, 16(11): 1331-1337.
[5] GU X C, WANG T S, DONG S J, et al. Evalutation and comparison of practice guidelines and consensus on type 2 diabetes: a systematic apprasial[J]. Chin Pharm J(中国药学杂志), 2016, 51(18): 1626-1630.
[6] WORKOWSKI K A, BOLAN G A. Centers for disease control and prevention[J]. MMWR Recomm Rep, 2015, 64(33): 924.
[7] SHERRARD J, WILSON J, DONDERS G, et al. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge[J]. Int J STD AIDS, 2018, 29(13): 1258-1272.
[8] YUDIN M H, MONEY D M. No. 211-screening and management of bacterial vaginosis in pregnancy[J]. J Obstet Gynaecol Can, 2017, 39(8): e184-e191.
[9] OWENS D K, DAVIDSON K W, KRIST A H, et al. Screening for bacterial vaginosis in pregnant persons to prevent preterm delivery[J]. JAMA, 2020, 323(13): 1286-1292.
[10] Vaginitis in nonpregnant patients: ACOG practice bulletin, number 215[J]. Obstet Gynecol, 2020, 135(1): e1-e17.
[11] VAN S J, YUDIN M H, INFECTIOUS DISEASE COMMITTEE. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis[J]. J Obstet Gynaecol Can, 2015, 37(3): 266-274.
[12] INFECTIOUS DISEASES COOPERATION GROUP OF CHINESE MEDICAL ASSOCIATION OBSTETRICS AND GYNECOLOGY. Guideline on treatment and diagnosis of bacterial vaginosis[J]. Chin J Obstet Gynecol(中华妇产科杂志), 2011, 46(4): 317.
[13] JIANG Z M, ZHAN S Y, JIA X W, et al. Basic methods and procedures for formulating/revising " clinical diagnosis and treatment guidelines " [J]. Nat Med J China(中华医学杂志), 2016, 96(4): 250-253.
[14] SU S, HE N, ZHAI S D. Methodology and thinking of updating clinical practice guidelines[J]. Clin Med J (临床药物治疗), 2020, 18(6): 26-30.
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