原發(fā)性醛固酮增多癥診斷指引的評(píng)價(jià)-2019年文檔

1、原發(fā)性醛固酮增多癥診斷指南的評(píng)價(jià)Purpose: There has been a rapid expansion in the number of clinical practice guidelines for primary aldosteronism (PA) over the past decade, but little is known about which guidelines(GLs) to follow. Therefore, this study is done to assess the quality of the GLs, and to give advice o

2、n the recommendation on diagnosis of PA for future. Methods: After systematic searches of pubmed and electronic guideline databases between 1999 and 2008, 9 PA GLs were selected and scored for methodological quality using the AGREE Instrument. Then we extracted and compared recommendations amonga ra

3、nge of guideline and analyzed to what extent the variation or concordance among recommendations was explained by the evidence cited in the guideline.Results: Of the 3192 referrences, 9 GLs were evaluated by the AGREE instrument. 2 GLs, were strongly recommended, and 2 GLs ,recommended with alteratio

4、n, but 5 GLs would not be recommend. The recommendations made in the guidelines were in agreement about general diagnosis of PA, with some important differences in details. There was little overlap in evidence cited by the guidelines.Conclusions: It is evident that there are disparities in diagnosti

5、c recommendation in guidelines for PA, reflecting unsystematic guideline development, insufficient evidence, differing interpretation of evidence, the influence of professional bodies. Therefore, efforts will be further needed to close the evidence gaps in the field of the diagnosis of PA and to cre

6、ate a joint task force to reach a common document by using the AGREE criteria.KeywordsAGREE;primary aldosteronism;diagnose;guideline;evidence-based medicine引言 原發(fā)性醛固酮增多癥是由醛固酮分泌過(guò)多所致的一種常見(jiàn) 的內(nèi)分泌性高血壓。原發(fā)性醛固酮增多癥在普通的高血壓中占 6.1%1, 在頑固性高血壓中占 17%2 或 20%3, 在腎上腺意外 瘤中占 1.6%4 。另外 , 越來(lái)越多地研究顯示原發(fā)性醛固酮增多 癥病人心血管事件的患病率和病死率

7、比同年齡 , 同性別的高血壓 病人更高 5 。而原發(fā)性醛固酮增多癥是需要根據(jù)不同的病因進(jìn) 行治療的 , 如醛固酮瘤需行單側(cè)腎上腺切除術(shù) , 而雙側(cè)腎上腺增 生需醛固酮受體拮抗劑的治療。 因此原發(fā)性醛固酮增多癥是一種 常見(jiàn)的可識(shí)別的 , 可治療的 , 預(yù)后較好的高血壓 , 同時(shí)也需要臨床 醫(yī)師的及時(shí)診斷與鑒別。但是原發(fā)性醛固酮增多癥的最佳診斷方法現(xiàn)仍有爭(zhēng)議 6, 而專家們?cè)噲D通過(guò)臨床實(shí)踐指南來(lái)解決這個(gè)問(wèn)題。近 10 年來(lái)關(guān) 于原發(fā)性醛固酮增多癥的診斷指南層出不窮 , 卻沒(méi)有關(guān)注這些指 南質(zhì)量的好壞。 McAlister 等人發(fā)現(xiàn) , 不同的指南針對(duì)同種疾病 狀態(tài)建議不同 , 甚至所引用的證據(jù)也不

8、同 7 。因此在本研究中 , 我們運(yùn)用世界公認(rèn)的AGREE（8工具來(lái)對(duì)各個(gè)原發(fā)性醛固酮增多 癥診斷指南進(jìn)行評(píng)價(jià) , 其目的是 : 評(píng)價(jià)原發(fā)性醛固酮增多癥的 診斷指南質(zhì)量 ; 指南所提供的建議是否符合指南發(fā)展過(guò)程中的 循證醫(yī)學(xué)的要求 ; 比較不同指南之間證據(jù)和建議的一致性 ; 對(duì)原發(fā)性醛固酮增多癥的篩查和確診實(shí)驗(yàn)提出一些建設(shè)性的建 議。1 材料和方法1.1 檢索的步驟系統(tǒng)性的檢索了有關(guān)原發(fā)性醛固酮增多癥 , 高血壓 , 頑固性 高血壓和腎上腺意外瘤的指南的文獻(xiàn)。目的是獲得易檢索的, 能在多個(gè)國(guó)家使用的 , 具有代表性的原發(fā)性醛固酮增多癥診斷指南 的樣本。檢索主題詞為高血壓 /診斷/ 指南或腎上腺意外瘤等 （ 見(jiàn) 表1）。分別由兩個(gè)評(píng)價(jià)者獨(dú)立地在 PubMed,NGC美國(guó)國(guó)內(nèi)指南數(shù) 據(jù)庫(kù)）,GIN（國(guó)際指南網(wǎng)）和NICE（英國(guó)國(guó)內(nèi)健康與臨床研究所）中 進(jìn)行查找。1.2 檢索條件1.3 數(shù)據(jù)提取和指南方法學(xué)質(zhì)量的評(píng)估兩個(gè)評(píng)估者獨(dú)立地審閱了相關(guān)的指南 , 提取了原發(fā)性醛固酮 增多